Systematic ReviewGuideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain
Introduction
To improve the knowledge base concerning the diagnosis and treatment of nonspecific low back pain in adult patients, the Low Back Pain Work Group of the North American Spine Society's (NASS) Evidence-Based Guideline Development Committee developed an evidence-based clinical guideline on this topic. When employing the principles of evidence-based medicine, the clinical literature is extensively searched to answer specific clinical questions about a disease state or medical condition. The literature, identified in the search, is rated according to its scientific merit using NASS evidence analysis criteria and the levels of evidence as determined by specific rule sets that apply to human, clinical investigations. The evidence with the highest possible levels of evidence obtained from the searches is utilized to answer the specific clinical questions. As a final step, the answers to clinical questions are reformulated as recommendations. Recommendations are then assigned a recommendation grade according to the level of evidence for the best clinical evidence available at the time of answering each question. The intent of the grade of recommendation is to indicate the strength of evidence used by the work group in answering the question asked.
Section snippets
Methods
The methods used to develop this guideline and guideline development disclosure policies are detailed in the complete guideline [1] and technical report [2]. In brief (Figure), a multidisciplinary work group of spine care specialists, including representatives from the fields of primary care, psychology, neurosurgery, orthopedic surgery, physical medicine and rehabilitation (PM&R), chiropractic care, physical therapy, anesthesiology, research, and radiology, convened to identify clinical
Results
Eighty-two clinical questions were addressed in this guideline. Work group members engaged in a two-step screening process to determine article eligibility, including title and abstract screening and evidentiary review. The total number of articles retrieved, eligible for critical appraisal, and meeting inclusion criteria for each individual clinical question can be accessed in the technical report [2]. A total of 119 recommendations and two work group consensus statements were issued.
Summary of recommendations
Recommendations were graded according to the NASS Grades of Recommendation [4]. In summary, these are Recommendation Grade A=Good evidence, Recommendation Grade B=Fair evidence, Recommendation Grade C=Poor quality evidence, and I=Insufficient or conflicting evidence. The recommendations are summarized below.
Discussion
This evidence-based clinical guideline for the diagnosis and treatment of low back pain has several functions. It is an educational tool for both clinicians and patients, and as such this particular guideline is intended to assist practitioners who treat adult patients with nonspecific low back pain. This guideline also serves to focus and rate the scientific data on this topic. An evidence-based guideline such as this allows a clinician access to the best and most current evidence and reduces
Acknowledgments
Development of this guideline was funded in its entirety by the North American Spine Society (NASS) with the exception that stakeholder societies provided representatives and paid for the travel and accommodation of their representatives to recommendation meetings. The NASS Evidence-Based Guideline Development Committee developed this guideline.
All participating authors have disclosed potential conflicts of interest consistent with NASS’ disclosure policy (http://www.spine.org/DisclosurePolicy
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Author Disclosures: All participating authors have disclosed potential conflicts of interest consistent with NASS' disclosure policy (http://www.spine.org/DisclosurePolicy). The Technical Report associated with this document includes the disclosures of all authors and contributors along with a description of participating and contributing societies. It is available at: https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPainTechReport.pdf. AMY: Staff at the North American Spine Society. KAR: Staff at the North American Spine Society 2012-2017