Premium
Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Author(s) -
Wong J.J.,
Côté P.,
Sutton D.A.,
Randhawa K.,
Yu H.,
Varatharajan S.,
Goldgrub R.,
Nordin M.,
Gross D.P.,
Shearer H.M.,
Carroll L.J.,
Stern P.J.,
Ameis A.,
Southerst D.,
Mior S.,
Stupar M.,
Varatharajan T.,
TaylorVaisey A.
Publication year - 2017
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.931
Subject(s) - medicine , manual therapy , cinahl , chiropractic , physical therapy , spinal manipulation , low back pain , critical appraisal , medline , systematic review , acupuncture , rehabilitation , protocol (science) , alternative medicine , psychological intervention , nursing , pathology , political science , law
We conducted a systematic review of guidelines on the management of low back pain ( LBP ) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE , EMBASE , CINAHL , Psyc INFO , Cochrane, DARE , National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high‐quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self‐management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti‐inflammatory drugs ( NSAID s), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAID s, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAID s as first‐line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited. Significance Most high‐quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/ NSAID s as first‐line treatments for LBP . Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.