Varrassi Giustino, Moretti Biagio, Pace Maria Caterina, Evangelista Paolo, Iolascon Giovanni
Paolo Procacci Foundation, Rome, Italy.
Orthopedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", Bari, BA, Italy.
Pain Ther. 2021 Jun;10(1):589-604. doi: 10.1007/s40122-021-00249-w. Epub 2021 Mar 13.
Low back pain (LBP) is a common reason for adults to seek medical care and is associated with important functional limitation and patient burden. Yet, heterogeneity in the causes and presentation of LBP and a lack of standardization in its management impede effective prevention and treatment.
We conducted a modified Delphi study to generate consensus statements for the diagnosis, management, and prognosis of LBP. A panel of five experts proposed 19 statements that were subsequently evaluated by physicians who treat LBP in their everyday clinical practice. Physicians were asked to validate statements in the form of a web survey assessing level of agreement on a five-point Likert-like scale.
Consensus (≥ 70% agreement) was obtained for all 19 statements. Strength of agreement and physician comments highlighted the importance of pain management, but also strategies to ameliorate functional limitation and prevent future LBP episodes. Respondents favored multidisciplinary approaches and multimodal management for LBP, although there was some ambiguity as to how multidisciplinary strategies could be feasibly incorporated into daily practice. Finally, the results indicated some conflict regarding the use of imaging for the diagnosis of LBP and how to classify LBP for targeted treatment.
The results of this study provide a summary of favored clinical practice for the management of chronic LBP. While the consensus statements were generally agreeable to survey respondents, some areas of ambiguity, including how to increase the feasibility of multidisciplinary strategies, when and how to use diagnostic imaging in LBP, and LBP classification, necessitate clarification in future studies and guidelines.
下腰痛（LBP）是成年人寻求医疗护理的常见原因，并且与重要的功能受限和患者负担相关。然而，下腰痛病因和表现的异质性以及其管理缺乏标准化阻碍了有效的预防和治疗。
我们进行了一项改良的德尔菲研究，以就下腰痛的诊断、管理和预后达成共识声明。一个由五名专家组成的小组提出了19条声明，随后由在日常临床实践中治疗下腰痛的医生进行评估。医生们被要求以网络调查的形式对声明进行验证，该调查使用类似李克特量表的五点量表来评估一致程度。
所有19条声明均达成了共识（≥70%的一致率）。一致程度的强度和医生的评论突出了疼痛管理的重要性，以及改善功能受限和预防未来下腰痛发作的策略。受访者赞成对下腰痛采用多学科方法和多模式管理，尽管对于如何将多学科策略切实纳入日常实践存在一些模糊之处。最后，结果表明在使用影像学诊断下腰痛以及如何对下腰痛进行分类以进行靶向治疗方面存在一些冲突。
本研究结果总结了慢性下腰痛管理中普遍认可的临床实践。虽然共识声明总体上得到了调查受访者的认同，但一些模糊领域，包括如何提高多学科策略的可行性、何时以及如何在诊断下腰痛时使用诊断影像学以及下腰痛的分类，需要在未来的研究和指南中加以澄清。
