Quality of Low Back Pain Guidelines Improved

Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Spine (Impact Factor: 2.45). 10/2009; 34(23):2562-7. DOI: 10.1097/BRS.0b013e3181b4d50d
Source: PubMed

ABSTRACT Systematic review of clinical guidelines.
To assess the methodological quality of clinical guidelines for the management of acute and chronic low back pain (LBP) in primary care and compare their recommendations.
A guideline evaluation performed in 2004 concluded that the quality and transparency of the development process and consistency in the reporting of primary care guidelines for LBP need to be improved. At present, several guidelines have been revised and new guidelines are published. We evaluated if the quality of guidelines has improved.
Guidelines published since 2004 were selected by electronically searching in MEDLINE, Cochrane Back Review Group database, Guideline Clearing House, Google, and contacting experts. The methodological quality of the guidelines was assessed by 2 authors independently, using the Appraisal of Guidelines, Research, and Evaluation in Europe instrument. Also, the diagnostic and therapeutic recommendations were compared.
Fourteen guidelines were included. In general, the quality was satisfactory. The guidelines had best scores on clarity and presentation. The domain scores of scope and purpose were often moderate due to the absence of description of the clinical questions. The domain of stakeholder involvement scored moderate, mostly because guidelines were not tested among target users. Domains that had generally low scores were applicability and editorial independence. Four guidelines scored low on the rigor of development, but the other guidelines scored high on this domain.The diagnostic and therapeutic recommendations in the guidelines for acute LBP were mainly comparable while the recommendations for the management of chronic LBP varied widely.
Compared to the quality assessment performed in 2004, the average quality of guidelines has improved. However, guideline developers should still improve the quality transparency of the development process. Especially the applicability of guidelines and the editorial independence need to be ensured in future guidelines.

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    • "A recurring conclusion of high quality systematic reviews and randomised controlled trials (RCTs) in the field of back pain is that most treatments show modest effects compared to natural course, and small or no differences between the effectiveness of different interventions [1] [2] [3] [4]. This leads to equivocal and sometimes contradictory messages in clinical practice guidelines [5] [6], and frustration in clinicians attempting to provide evidence-based care for their patients. In part, the underwhelming results reported by these studies are likely due to incomplete understanding of what factors might be necessary to include in interventions to help influence outcome. "
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    ABSTRACT: Mediation analysis is a useful research method that potentially allows identification of the mechanisms through which treatments affect patient outcomes. This chapter reviews the theoretical framework, research designs and statistical approaches used in mediation analysis. It describes what can be learnt from previous mediation research, much of which has investigated mediating factors of psychosocial interventions in other health conditions. It also summarises the few treatment-mediation studies of psychosocial interventions conducted in back pain. This chapter shows that there is emerging evidence about the role of some psychological factors as potential treatment mediators, such as self-efficacy and catastrophising. Mediation analysis can equally be applied to non-psychological factors. Pre-planned and appropriately conducted mediation analysis in adequately powered clinical trials would be a step forward in understanding treatment effects in back pain and improving patient management.
    Best practice & research. Clinical rheumatology 10/2013; 27(5):685-97. DOI:10.1016/j.berh.2013.10.001 · 3.06 Impact Factor
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    • "de recherche utilisé était « low back pain » ; • le web mondial (jusqu'à décembre 2010) avec les moteurs de recherche Google et Google scholar, en utilisant le terme « low back pain guideline » et la même combinaison avec « guidelines » ; • des recommandations supplémentaires ont été identifiées par la recherche manuelle au sein des références des éléments sélectionnés , recommandations, article et revues générales [13] "
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    • "The authors concluded that there is strong evidence that exercise therapy is not more effective than no treatment or other conservative treatments for acute LBP. Two recent papers summarised the quality and content of 25 international clinical guidelines on the management of LBP [17] [18]. There seems to be consensus about the optimal management for acute LBP. "
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