Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
PhD Course in Integrative Biomedical Research, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy.
Eur Spine J. 2018 Nov;27(11):2781-2790. doi: 10.1007/s00586-018-5763-1. Epub 2018 Sep 15.
To assess the methodologic quality of guidelines for the management of low back pain (LBP) and compare their recommendations.
No ethics committee approval was needed for this systematic review. 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.
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.
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.
评估腰痛（LBP）管理指南的方法学质量，并比较其推荐意见。
本系统评价不需要伦理委员会批准。2017 年 3 月，使用 MEDLINE、EMBASE、国家指南清除库和国家卫生与临床卓越研究所进行了系统搜索，以查找腰痛评估和管理的实践指南。四位作者独立使用 AGREE II 工具评估指南的质量，结果与 2004 年和 2009 年进行的先前评估进行了比较。
从 114 篇检索到的指南中，有 8 篇被评估。除了一篇之外，所有指南的总体结果均达到了“可接受”水平，其中有 2 篇达到了最高分数。只有 2 篇指南在所有领域都达到了“可接受”水平；其余指南至少有一个领域的分数较低。指南在“范围和目的”和“表述清晰度”方面的得分较高（范围为 63%-94%）（47%-89%）。“利益相关者参与”是指南结果之间差异最大的领域（40%-96%）。“制定的严谨性”达到了中等平均水平（34%-90%），“适用性”（42%-70%）和“编辑独立性”（38%-85%）。只有 3 篇指南的作者中有放射科医生，与作者中没有放射科医生的指南相比，得分更高。与之前的评估相比，2004 年低水平指南占 53%，2009 年占 36%，2017 年占 13%。
考虑到所有指南，只有一篇指南的总体评分较低，而其中一半被评为高质量。未来的指南可能会考虑到这一点，以提高临床适用性。
