Occupational Medicine Unit, Department of Internal Medicine, Geriatrics and Nephrology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, via P. Palagi 9, 40138 Bologna, Italy.
Joint Bone Spine. 2012 Mar;79(2):176-85. doi: 10.1016/j.jbspin.2011.03.019. Epub 2011 May 12.
In the past decade many countries around the world have produced clinical practice guidelines to assist practitioners in providing a care that is aligned with the best evidence. The aim of this study was to present and compare the most established evidence-based recommendations for the management of chronic nonspecific low back pain in primary care derived from current high-quality international guidelines.
Guidelines published or updated since 2002 were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the World Wide Web. The methodological quality of the guidelines was assessed by three authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into diagnostic and therapeutic approaches that were supported by strong, moderate or weak evidence.
Thirteen guidelines were included. In general, the quality was satisfactory. Guidelines had highest scores on clarity and presentation and scope and purpose domains, and lowest scores on applicability. There was a strong consensus among all the guidelines particularly regarding the use of diagnostic triage and the assessment of prognostic factors. Consistent therapeutic recommendations were information, exercise therapy, multidisciplinary treatment, and combined physical and psychological interventions.
Compared to previous assessments, the average quality of the guidelines dealing with chronic low back pain has improved. Furthermore, all guidelines are increasingly aligning in providing therapeutic recommendations that are clearly differentiated from those formulated for acute pain. However, there is still a need for improving quality and generating new evidence for this particular condition.
在过去十年中，世界上许多国家都制定了临床实践指南，以帮助医生提供符合最佳证据的治疗。本研究旨在介绍和比较当前高质量国际指南中针对基层医疗中慢性非特异性下腰痛管理的最成熟的循证推荐。
通过搜索 PubMed、CINAHL、EMBASE、指南数据库和万维网，选择了自 2002 年以来发布或更新的指南。三位作者独立使用评估研究和评估指南（AGREE）工具评估指南的方法学质量。将指南建议综合为诊断和治疗方法，这些方法得到了强、中或弱证据的支持。
共纳入 13 项指南。总体而言，质量令人满意。指南在清晰度和表述、范围和目的方面得分最高，在适用性方面得分最低。所有指南在使用诊断分诊和评估预后因素方面达成了强烈共识。一致的治疗建议是信息、运动疗法、多学科治疗和综合身心干预。
与以前的评估相比，处理慢性下腰痛的指南的平均质量有所提高。此外，所有指南在提供治疗建议方面越来越一致，这些建议与针对急性疼痛制定的建议明显不同。然而，仍需要提高质量并为这种特殊情况生成新的证据。
