, Schulte, T. L. , Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Low Back Pain. The most common type of low back pain is called 'non-specific low back pain', and accounts . professional organization(s), country and target population/diagnostic classification). However, for the purposes of this review, we felt it was important to exclude guidelines that may not be based on uptodate evidence of effectiveness. , , ), Leitlinien fr Diagnostik und Therapie in der Neurologie [Lumbar radiculopathy, S2k Guideline 2018; In: German Society of Neurology (Ed), Guidelines for Diagnostics and Therapy in Neurology]. Each item is presented for scoring alongside detailed guidance on how to score the item, including where to find relevant information and what to consider when deciding on the score for each item. , Grusing, S. , , Recent evidencebased European clinical guidelines issued by professional bodies or organizations for guideline development [published from 2013 onwards]. , B. , Koes, B. W. Consistency of recommendations across guidelines for low back pain (see Appendix S6 for individual guidelines). Skelly, A. Locher, H. , The AGREE II (Appraisal of Guidelines Research and Evaluation) reporting checklist was used to critically appraise guidelines (Brouwers etal.,2010a). , Table4 presents the summary of recommendations from high and lowquality guidelines and the overall recommendations derived from our synthesis. Saunders, B. Data extracted included; aim and target population, methods for development and implementation and treatment recommendations. Criteria were devised to summarize and synthesize the direction and strength of recommendations across guidelines. Method: The searches for clinical practice guidelines were performed for . Objectives. Editorial independence). Pool, J. Source: UpToDate Online; Christopher L. Knight, MD; Richard A Deyo, MD, MPH; Thomas O Staiger, MD; Joyce E Wipf, MD. Lewis, M. Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.(Institute of Medicine, 1990). However, for most of these guidelines, the reviewer had the advantage of being involved in data extraction for English language guidelines, which helped to ensure consistency of data extraction and interpretation. Orlando, FL 32804, P: (800) 917-1619 Ext. An overview of characteristics of included CPGs and the methods used in their development and implementation is presented in Table1, with guidelinespecific details provided in Appendices S3 & S4. 10.1002/ejp.1679 , For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. 7. Stratified primary care versus nonstratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial. Linn, J. van Boxem, K. Koes, B. W. , Foster, N. E. This study aimed to review recommendations for the management of Chronic low Back Pain in primary care based on high-quality recent and recently updated Clinical practice Guidelines. , (2010b). In addition, our Back UP research partners were asked to identify any relevant guidelines from their country. AAPM guidelines are intended as educational tools for healthcare providers and are based on clinical expertise and a review of the relevant literature by diverse groups of highly trained clinicians. , & Hashimoto, R. 2020; 323: 863- 884. . All Rights Reserved | Privacy Policy | Media Resources | Powered by Insight Marketing Group This may be partly explained by fewer guidelines being produced in southern or eastern Europe, but also by the fact that we only included guidelines published in the past 7years. 2020. This review of European CPGs identified a range of mainly nonpharmacological recommended treatment options for NLBP that have broad consensus for use across Europe. Objective: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. %PDF-1.5 Clinical Practice Guidelines. Pain, 161 (2020), pp. The guideline is intended to improve patient outcomes and local management of patients with low back pain. The U.S. Department of Health and Human Services oversaw this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense. The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. Characteristics of included clinical practice guidelines. , Hanna, S. E. Feder, G. Updated NICE Guidelines for Lower Back Pain (2016) here: [1] NICE guidelines recommend a treatment package of, exercise, advice and education, and if necessary the inclusion of manual and psychological therapies. The instrument focuses on guideline development and reporting and consists of 23 items addressing 6 domains (1. , Prevention and treatment of low back pain: Evidence, challenges, and promising directions. Dobrzycka, A. (2017). , Visit the Clinical . Maserejian, N. N. Only seven CPGs (41%) were considered to be of overall high quality, with limitations mainly related to rigour of development (e.g. Acute Pain Management Clinical Guide / Quick Reference Guide: Adults / Pediatric Consumer Version: English / Spanish 2. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. Hans, G. Hendriks, E. J. M. , Results from all searches were imported into EndNote X9 (reference management software, Clarivate Analytics. <> , Wathall, S. , Haywood Hospital, , & Aug 31, 2020 clinical practice guidelines for midwifery and , Asthma 2020 focused update -Clinical practice guidelines from National Asthma Education and Prevention Program from US Dept of Health and Human Services (HHS) . , , More than 100 million Americans experience chronic pain, according to the National Institute on Drug Abuse. Future work within our BackUP research team will transfer these evidencebased treatment options to an accessible clinician decision support tool for first contact clinicians. (2017). , & , For specific cases: failure of nonsurgical treatment, moderate/severe persistent pain; specific indications e.g. Disease and Injury Incidence and Prevalence Collaborators. the display of certain parts of an article in other eReaders. For specific cases: subacute and chronic LBP with patient strongly motivated to resolve and/or psychosocial obstacles to recovery. for, against or open) and strength of recommendations were harmonized, taking into consideration the array of methods and terminologies used across included guidelines (see AppendixS2). Relevant outcomes also included evidencebased recommendations regarding factors (patient, clinician, environment) that may be associated with the effectiveness of treatment, and recommendations regarding clinical prediction rules or decision tools supporting the selection of treatment for specific patient subgroups (where mentioned in the guideline). We are experimenting with display styles that make it easier to read articles in PMC. Weimer, M. , & A data extraction form was purposively designed in Excel to record relevant information from each of the clinical practice guidelines included in the review. ^z9;9z,~a&7;pSA~?+`E]2(3 wOL9 Souza, N. M. Referral for imaging is only supported for those with red flags, such as increased risk of fracture, infection, (metastatic) cancer, neurological emergencies including cauda equina syndrome, aortic aneurysm or systemic inflammatory arthritis (detailed in AppendixS7), or deterioration of symptoms. Van Dam NT, van Vugt MK, Vago DR, et . "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."(Institute of Medicine, 1990) Issued by third-party organizations, and not NCCIH, these guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. , , & The recent Clinical Practice Guideline (CPG) 2021 synthesised the recent evidence around low back pain management and builds on our knowledge and understanding of this complex condition, low back pain. , Primary Care Centre Versus Arthritis, , (2009). , & , Two reviewers (NC and GM) independently screened all titles and abstracts for relevance against eligibility criteria and excluded ineligible publications by agreement. Future work within the BackUP research project will embed these evidencebased treatment options in an accessible clinician decisionsupport tool for first contact clinicians, aiming to offer patients with NLBP treatment options better matched to the risk of persistent pain and disability. , & vanderstraeten, J. 1 0 obj Ann Intern Med 2017; 166: 514-530. PisulaLewadowska, A. 2887-2897. Sundhedsstyrelsen (SST) [Danish Health Authority] Feder, G. Applicability and 6. We included recently published guidance only, to ensure treatment recommendations emerging from the review would be based on relatively uptodate evidence; Guidelines concern adult populations (18years or over), with NLBP (including patients presenting to first contact health professionals with symptoms of whiplashrelated disorders or symptoms of radiculopathy such as radicular pain); Guidelines that include recommendations regarding treatment options for patients presenting with NLBP, in particular: Treatments deliverable within primary care (as broadly considered across Europe, including occupational healthcare) or referral pathways from primary to secondary care recommended for clinical practice (in at least two European countries). Low back pain (LBP) is defined as pain located in the area between the posterior lower margins of the 12 th ribs and the gluteal folds, and may occur with associated lower limb pain/neurological involvement. , & Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) Maher, C. G. An a priori protocol was written and followed (Available at http://backupproject.eu/?page_id=84). Getting too little exercise followed by a strenuous workout also can cause back pain. Wilczynski, J. M. , , , These guideline products are no longer viewed as guidance for current medical practice, and are provided for archival purposes only. , Weimer, M. A. , A|oP>f) 1/NqxkvUQ|@-CraJSjz*%kJ,]%(YXr*U>6 ,I;&)^i?CixAZ PQ)cAc.]Wg9QG.jX:A*M.c.caTl _Q(#3sVB&:.QGCE{AJ+f E\Ga 5"DS" @Z1}kP3-G6eifvA,| XA Dalla Toffola, E. , , What Is Complementary, Alternative, or Integrative Health? Nordin, M. Parlevliet, T. , This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline (CPG) for LBP. (2017). , Treatment or referral options for which a recommendation was formulated in one guideline only, were not further considered. For the other databases, search terms were adapted to the search capabilities of the platform. The North American Spine Society (NASS) published Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care in early 2020. Developed by a group of multidisciplinary spine specialists, the guidelines are the first by NASS to address low back pain as a symptom potentially due to a variety of diagnoses rather than as a specific disease. van den Donk, M. Practice Guidelines Low Back Pain Clinical Practice Guidelines: Part 1 Overview . van Tulder, M. The substantial burden of illness from these conditions was shown by the most recent LancetGlobal Burden of Disease study which highlighted low back pain (LBP) as the single highest cause of years lived with disability (out of 354 conditions studied), with neck pain ranked eighth (female) and twelfth (male) (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). , Ostelo, R. We would like to show you a description here but the site won't allow us. (2016). Kadam, U. T. This is an open access article under the terms of the. Conversely, a minority of CPGs (n=7, 41%) achieved high ratings for Domain 5 (applicability). The following consensus guidelines continue under development. Mairiaux, P. ; Lancet Low Back Pain Series Working Group , , Moher, D. , <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Psychological or multimodal (multidisciplinary) interventions were recommended for specific subgroups of patients with neck pain, with either psychosocial risk factors or for those with more persistent neck pain or disability. Stoffel, M. (2014). Hausner, E. Goucke, R. The Low Back Pain Clinical Care Standard aims to improve the early assessment, management, review and appropriate referral of patients with this common health condition. National klinisk retningslinje for ikkekirurgisk behandling af nyopstede uspecifikke nakkesmerter [National clinical guideline for the nonsurgical treatment of recent onset nonspecific neck pain], Mal Di Schiena: Linee Guida Diagnostico Terapeutiche E Raccomandazioni Per La Costruzione Di Percorsi Assistenziali [Back pain: therapeutic and diagnostic guidelines and recommendations for treatment plans]. , Our team is part of BackUP, a European programme of research developing a digital health technology to support clinical decision making for patients with NLBP based on a stratified care approach for firstcontact consultations [http://backupproject.eu/]. 4 0 obj Hayward, R. Odense Interventional Spine And Pain Procedures In Patients On Antiplatelet And Anticoagulant Medications (Second Edition). National Institute for Health Care Excellence (NICE) 102 Bundesrztekammer (BK) Details regarding the specific treatment options or intervention modalities identified from each guideline can be found in AppendixS6, along with the direction and strength of each recommendation. , 2 0 obj Evidence-Based Practice Resources Clinical Practice Guidelines Management of Acute Low Back Pain in Adults Management of Acute Low Back Pain in Adults CPG Date:Tuesday, March 1, 2022 Overview The guideline recommends assessment, diagnosis and management of acute low back pain in adults (low back pain of 4 weeks duration). Garg, A. X. Pressure Ulcer Prevention Clinical Guide / Quick Reference Guide Skelly, A. Peul, W. American Academy of Pain (AAMP) is a nonprofit, 501(c)(3) tax-exempt organization. Internationally, this is the most widely used tool for assessing guideline quality (Siering etal.,2013), with good construct validity and reliability (Brouwers etal.,2010b, 2010c). who highlighted that guidelines for patients with thoracic pain are lacking (Lin etal.,2020), we only identified one (low quality) guideline (Kassolik etal.,2017) that specifically addressed thoracic pain. 1 The lifetime incidence of low back pain is 58-84%, 2 and 11% of men and 16% of women have chronic low back pain. , Desomer, A. , endobj Finding solutions that promote bestpractice care for patients with NLBP in firstcontact consultations is therefore a priority (Foster etal.,2012). Full texts were independently assessed for inclusion by pairs of independent reviewers (NC, GM and DvdW). Fraselle, V. , Leimert, M. , Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (2017) . , (2013). U.S. Department of Health and Human Services. , & UpToDate 03192020 Menopause Management of Menopausal Symptoms. Munting, E. The strength of this review is that it provides a helpful overall summary of the treatment and referral recommendations from recent European guidelines for NLBP. For example referrals to secondary care specialists are too common, provision of selfmanagement advice and education can be limited, opioids and imaging are overprescribed, and signposting to locally available nonpharmacological options such as exercise groups are limited (Chou, etal.,2017a; Koes etal.,2010; Maserejian etal.,2014). (2016c). Straker, L. , McKinlay, J. Michielsen, J. , For neck pain, highquality guidelines consistently recommended the following evidencebased treatment options: reassurance, advice and education (including to remain active and exercise), manual therapy in combination with other treatment, referral for exercise therapy/programme and a range of oral analgesics and topical medications, plus psychological therapies or multidisciplinary treatment for specific subgroups of patients. , Kerry S, Hilton S, Dundas D, Rink E, Oakeshott P. Radiography for low back pain: a randomised controlled trial and observational study in primary care. Other injections including intravenous, intramuscular, infiltration of trigger points and ligaments, intradiscal infiltration, prolotherapy, Botulium toxin, Thermotherapy including local heat, hot/cold compresses, baths, sauna, Manual therapy including mobilisation, manipulation and softtissue techniques, Postural therapies e.g. Campbell, P. 2 CK \u0026 Shelf Exam Using Clinical Practice Guidelines in Daily Practice An Evidence-Based Look at Clinical Practice Guidelines (CPGs) - TI Methods Speaker Series 2020 Clinical Guidelines In Family Practice Buy Clinical Guidelines in Family Practice 5th ed. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition . In fact, for low back pain the guidelines recommended entirely nonpharmacological treatments, additionally including workbased interventions, advice/programmes to return to work and surgical intervention for specific subgroups. (2012). Wiles, L. We also aimed to examine how recommendations have changed since our last overview in 2010. Ostelo, R. W. J. G. Schaafstra, A. Kraegel, P. Griffin, J. , & (2017). Hill J. C., Garvin S., Chen Y., Cooper V., Wathall S., Saunders B., Lewis M., Protheroe J., Chudyk A., Dunn K. M., Hay E., van der Windt D., Mallen C., Foster N. E. (2020). Pirotte, B. , , Date: Friday, December 11, 2020 Overview. , Except: for a few days in severe/acute cases, Antidepressants including SSRIs, SNRIs, Tricyclics, For specific cases: comorbid depression (BK et al., 2017, high quality) or chronic pain [tricyclics only] (Glocker et al., 2018, low quality), Anticonvulsants/Antiepileptics including gabapentin, pregablin, carbamazepine, topiramat, Muscle relaxants including diazepines/benzodiazepines, For specific cases: nonspecific LBP where nondrug and nonopioid treatments ineffective (BK et al., 2017, high quality); 2, Electrotherapy including laser therapies, TENS, PENS, shortwave diathermy, US, ultrashortwave, inferential, magnetic field, electromagnetic, light therapy, shockwave, electrostimulation, Orthoses including belts, corsets, foot orthotics, insoles, rocker shoes, pullups, walking stick, elbow crutches and bands, Opioids (including tramadol) +/ paracetamol (or NSAIDs). , The treatment options identified in this study are also broadly similar and consistent with two recent systematic reviews of clinical practice guidelines for musculoskeletal pain (Lin etal.,2020) and back pain (Oliveira etal.,2018) which identified similar key management recommendations (patient information, physical activity advice, return to work interventions, exercise interventions), although Oliveira et al., additionally identified antidepressants (for chronic LBP), NSAIDs and weak opioids for short periods of time (for acute LBP) to be frequently recommended across guidelines. van Lerbeirghe, J. Kraegel, P. Staal, J. This overview enabled us to identify treatment options that have been consistently recommended across eight different countries and can therefore be considered to have broad European consensus. On the basis of the quality of the evidence we have identified a short list of treatment options recommended for the management of NLBP (see Table5). RajkowskaLabon, E. , You, J. J. , , , Incidence and prevalence of complaints of the neck and upper extremity in general practice. Oppong, R. Schellevis, F. G. Siering, U. van Zundert, J. 1-4 visits per month. . Friedly, J. , 6,7 , Jonckheer, P. Gross, D. P. (2017). <> Mokrusch, T. Koes, B. W. Issued by third-party organizations, and not NCCIH, these guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. KNGFrichtlijn Lage rugpijn: Praktijkrichtlijn [KNGF clinical practice guideline for physical therapy in patients with low back pain]. Foster, N. E. , , Sundhedsstyrelsen (SST) [Danish Health Authority] referral to surgery). <> , Depreitere, B. The guideline aims to improve people's quality of life by promoting the most effective forms of care for low back pain and sciatica. Cherkin, D. Reference lists of included guidelines were checked to identify additional documents relevant to the methodology of the guideline. Between 1992 and 1996, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) sponsored development of a series of 19 clinical practice guidelines. , Borg, M. A. J. P. , Follow AAPM on Facebook or Twitter and stay tuned to our newsfeed for the latest updates in Pain Medicine news. , Verhulst, D. , Fervers, B. , Version 1. The guidelines included in our review came from eight European countries (UK, Germany, France, Italy, Denmark, Poland, Belgium and the Netherlands). Cohen, S. P. Cote, P. , The national standard was released by the Commission on 1 September 2022. Terwee, C. B. Berquin, A. Fahey, T. Low back pain and sciatica in over 16s: assessment . Low back pain (LBP) is a common presentation in general practice. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Annals of Internal Medicine 2007 (Oct 2); 147 (7): 478-491 ~ FULL TEXT Low back pain is the fifth most common reason for all physician visits in the United States.
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