Ng Jeremy Y, Mohiuddin Uzair
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Eur Spine J. 2020 Aug;29(8):1833-1844. doi: 10.1007/s00586-020-06393-9. Epub 2020 Mar 31.
Individuals with low back pain (LBP) often turn to complementary and alternative medicine (CAM) to seek relief. The purpose of this study was to determine mention of CAM in LBP clinical practice guidelines and assess the quality of CAM recommendations using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.
A systematic review was conducted to identify LBP guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines providing CAM recommendations were assessed with the AGREE II instrument.
From 181 unique search results, 22 guidelines on the treatment and/or management of LBP were found, and 17 made recommendations on CAM therapy. With regard to scaled domain percentages, this overall guideline scored higher than the CAM section for 4 of 6 domains (overall, CAM): (1) scope and purpose (88.6%, 87.1%), (2) clarity of presentation (83.0%, 73.2%), (3) stakeholder involvement (57.0%, 41.7%), (4) rigor of development (47.2%, 44.7%), (5) editorial independence (34.8%, 34.8%) and (6) applicability (31.8%, 21.8%).
The majority of LBP guidelines made CAM recommendations. The quality of CAM recommendations is significantly lower than overall recommendations across all domains with the exception of scope and purpose and editorial independence. This difference highlights the need for CAM recommendation quality improvement. Future research should identify CAM therapies which are supported by sufficient evidence to serve as the basis for guideline development. These slides can be retrieved under Electronic Supplementary Material.
腰痛患者常求助于补充和替代医学（CAM）以寻求缓解。本研究旨在确定腰痛临床实践指南中对CAM的提及情况，并使用《指南研究与评价II》（AGREE II）工具评估CAM推荐的质量。
进行系统评价以识别腰痛指南。检索了2008年至2018年的MEDLINE、EMBASE和CINAHL。还检索了国际指南网络和国家补充与综合健康中心网站。使用AGREE II工具对提供CAM推荐的合格指南进行评估。
从181个独特的搜索结果中，发现了22条关于腰痛治疗和/或管理的指南，其中17条对CAM疗法提出了建议。在各领域的评分百分比方面，总体指南在6个领域中的4个领域（总体、CAM）得分高于CAM部分：（1）范围和目的（88.6%，87.1%），（2）表述清晰度（83.0%，73.2%），（3）利益相关者参与度（57.0%，41.7%），（4）制定的严谨性（47.2%，44.7%），（5）编辑独立性（34.8%，34.8%）和（6）适用性（31.8%，21.8%）。
大多数腰痛指南提出了CAM推荐。除范围和目的以及编辑独立性外，CAM推荐在所有领域的质量均显著低于总体推荐。这种差异凸显了提高CAM推荐质量的必要性。未来的研究应确定有充分证据支持的CAM疗法，以作为指南制定的基础。这些幻灯片可在电子补充材料中获取。
