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An updated overview of clinical guidelines for chronic low back pain management in primary care.

Abstract：

OBJECTIVES:In the past decade many countries around the world have produced clinical practice guidelines to assist practitioners in providing a care that is aligned with the best evidence. The aim of this study was to present and compare the most established evidence-based recommendations for the management of chronic nonspecific low back pain in primary care derived from current high-quality international guidelines. METHODS:Guidelines published or updated since 2002 were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the World Wide Web. The methodological quality of the guidelines was assessed by three authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into diagnostic and therapeutic approaches that were supported by strong, moderate or weak evidence. RESULTS:Thirteen guidelines were included. In general, the quality was satisfactory. Guidelines had highest scores on clarity and presentation and scope and purpose domains, and lowest scores on applicability. There was a strong consensus among all the guidelines particularly regarding the use of diagnostic triage and the assessment of prognostic factors. Consistent therapeutic recommendations were information, exercise therapy, multidisciplinary treatment, and combined physical and psychological interventions. CONCLUSION:Compared to previous assessments, the average quality of the guidelines dealing with chronic low back pain has improved. Furthermore, all guidelines are increasingly aligning in providing therapeutic recommendations that are clearly differentiated from those formulated for acute pain. However, there is still a need for improving quality and generating new evidence for this particular condition.

journal_name

Joint Bone Spine

journal_title

Joint bone spine

authors

Pillastrini P,Gardenghi I,Bonetti F,Capra F,Guccione A,Mugnai R,Violante FS

doi

10.1016/j.jbspin.2011.03.019

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

176-85

issue

2

eissn

1297-319X

issn

1778-7254

pii

S1297-319X(11)00077-7

journal_volume

79

pub_type

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