Low Back Pain Guideline

Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of low back pain ¹⁾.

In March 2017, a systematic search was performed using MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence to find practice guidelines of assessment and management of LBP. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool, and the results were compared with previous appraisals performed in 2004 and 2009. RESULTS:

Of 114 retrieved guidelines, eight were appraised. All except one reached the level of “acceptable” in overall result, with two of them reaching the highest scores. Only two guidelines reached a level of “acceptable” in every domain; the others had at least one domain with low scores. The guidelines had the higher scores (range = 63-94%) on “Scope and purpose” and “Clarity of presentation” (47-89%). “Stakeholder Involvement” has the highest variability between the guidelines results (40-96%). “Rigor of Development” reached an intermediate mean result (34-90%), “Applicability” (42-70%), and “Editorial Independence” (38-85%). Only three guidelines had a radiologist among authors and reached higher scores compared to guidelines without a radiologist among the authors. Compared to previous assessments, low-level guidelines were 53% in 2004, 36% in 2009, and 13% in 2017. CONCLUSIONS:

Considering all guidelines, only one had a “low” overall score, while half of them were rated as of “high” quality. Future guidelines might take this into account to improve clinical applicability ²⁾.

¹⁾

Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC 3rd, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL Jr, Robbins DS, Rosoloski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro A. Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020 Apr 22. pii: S1529-9430(20)30141-8. doi: 10.1016/j.spinee.2020.04.006. [Epub ahead of print] Review. PubMed PMID: 32333996.

²⁾

Doniselli FM, Zanardo M, Manfrè L, Papini GDE, Rovira A, Sardanelli F, Sconfienza LM, Arana E. A critical appraisal of the quality of low back pain practice guidelines using the AGREE II tool and comparison with previous evaluations: a EuroAIM initiative. Eur Spine J. 2018 Sep 15. doi: 10.1007/s00586-018-5763-1. [Epub ahead of print] Review. PubMed PMID: 30220040.