Meroni Roberto, Piscitelli Daniele, Ravasio Claudio, Vanti Carla, Bertozzi Lucia, De Vito Giovanni, Perin Cecilia, Guccione Andrew A, Cerri Cesare G, Pillastrini Paolo
School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.
Zucchi Clinical Institutes, Carate Brianza, Italy.
Disabil Rehabil. 2021 Apr;43(7):1029-1043. doi: 10.1080/09638288.2019.1645888. Epub 2019 Aug 1.
Chronic low back pain represents a major problem throughout the world which is increasing largely because of the aging world population. Clinical practice Guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision making. 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.
CINHAL, PubMed, EMBASE, PEDro, Google Scholar, Government websites, Scientific Association websites were searched until April 2019. The retrieved documents underwent several consecutive selection steps: semi-automated duplicate screening, documents selection based on title and abstract screening. Finally, three independent investigators screened the documents for the selected inclusion criteria and reviewed the retrieved documents by means of the AGREE II instrument.
A total of 3055 records were retrieved, of which 10 Clinical practice Guidelines met the inclusion criteria. The overall quality of these Clinical practice Guidelines was moderately variable. The recommendations of four Clinical practice Guidelines deemed as "excellent" were extracted and summarized. Although we tried to implement the most comprehensive research strategies, some Clinical practice Guidelines may be missing due to publication bias or incomplete indexing.
This study showed a partial progress in respect of the methodological quality of the Clinical practice Guidelines. Several AGREE II domains demonstrated low scores, particularly the "applicability" and "monitoring and auditing criteria" are the domains most susceptible to amendments in future.Implications for rehabilitationClinicians should be aware that among recently published/updated clinical practice guidelines for the management of chronic low back pain in primary care only few were deemed to have high quality.Increasing evidence suggests the efficacy for self-management to improve low back pain outcome.Physical treatments are recommended in order to improve low back pain outcome while many physical modalities such as TENS, ultrasound, laser therapy are not.Psychological treatments are recommended and should be included as part of a broader treatment plan.
慢性腰痛是全球范围内的一个主要问题，由于世界人口老龄化，其发病率在大幅上升。临床实践指南可以成为促进循证实践的有力工具，因为它们整合研究结果以支持决策制定。本研究旨在基于近期高质量且最近更新的临床实践指南，回顾基层医疗中慢性腰痛管理的推荐意见。
检索截至2019年4月的CINHAL、PubMed、EMBASE、PEDro、谷歌学术、政府网站、科学协会网站。检索到的文献经过多个连续筛选步骤：半自动重复筛选、基于标题和摘要筛选进行文献选择。最后，三名独立研究人员根据选定的纳入标准筛选文献，并通过AGREE II工具对检索到的文献进行评估。
共检索到3055条记录，其中10篇临床实践指南符合纳入标准。这些临床实践指南的总体质量存在一定差异。提取并总结了4篇被评为“优秀”的临床实践指南的推荐意见。尽管我们试图采用最全面的研究策略，但由于发表偏倚或索引不完整，可能仍有一些临床实践指南未被纳入。
本研究显示临床实践指南在方法学质量方面取得了部分进展。AGREE II的几个领域得分较低，特别是“适用性”和“监测与审核标准”是未来最容易修改的领域。对康复的启示临床医生应意识到，在近期发表/更新的基层医疗中慢性腰痛管理的临床实践指南中，只有少数被认为质量较高。越来越多的证据表明自我管理对改善腰痛结局有效。推荐采用物理治疗来改善腰痛结局，而许多物理治疗方式如经皮电刺激神经疗法、超声、激光治疗则不推荐。推荐采用心理治疗，且应将其作为更广泛治疗计划的一部分。
