Red Flag

Principal Investigator: Prof James Selfe

Project Fact File

Start DateJuly 2018
End DateJuly 2018
Funded by

Chartered Society of Physiotherapy (CSP)

Project TeamProf James Selfe
Mo Yusuf
External Providers and CollaboratorsLaura Finucane, Sussex MSK Partnership

Principal Investigator

Meet Prof James Selfe

Prof James Selfe

Professor, physiotherapist, MSK

Phone +44 (0)161 247 2965

Project Details


Physiotherapists have traditionally used Red Flags worldwide to help in the early identification of patients with serious spinal pathology. Red flags are signs and symptoms that are possible indicators of serious spinal pathology but there is no clinical evidence or guidance on how these should be used. A previously funded CSP project - The clinical guidelines for the physiotherapy management of persistent low back pain (CSP 2007) reported that there were 163 individual items that could be considered as Red Flags;

Clearly this presents a problem in terms of the practical clinical utility of Red Flags. In addition the use of Red Flags is problematic as there is no high-quality evidence on the diagnostic accuracy of their use (Henschke et al. 2013, Downie et al. 2013).

Currently there is no International consensus on which Red Flags might be useful in the identification of serious spinal pathology or on how they should be used in the clinical setting (Verhagen et al. 2016). The need for further research to provide data on the diagnostic accuracy of Red Flags was identified following a consultation of the member organizations of the International Federation of Orthopaedic Manipulative physiotherapists (IFOMPT) a sub group of WCPT in 2016. Listed below are the four key areas which were identified where systematic reviews are urgently required

This is one arm of a group of 4 international, linked studies into diagnosing Serious Spinal pathologies initiated by the International Federation of Manipulative Physical Therapists (IFOMPT). The other 3 arms are

Aims and Objectives

To conduct a systematic review on the Red Flags which have diagnostic value in the identification of patients with Back pain who may have an early stage spinal infection



We visited the Sheds to talk to the co-ordinators and the men pre developing our tender. We were the only bidding team to visit the Sheds. Relationship development with Age UK Cheshire. 

We are conducting a Systematic review which is registered with PROSPERO so will be following a standard methodology.

You can find out more following this link

On completion of the review we will be conducting an assessment of the findings using the QUADAS-2 tool to assess the quality of the diagnostic accuracy of Red Flags.


We are planning

This project is one part of a series of 4 projects which form the background work to a large international collaboration.  The next stage of the collaboration is to use the 4 completed systematic reviews to generate a consensus on which are the most evidence based and useful Red Flags to use to identify early serious pathology in patients complaining of back pain.