Faculty of Medicine, Health, and Human Sciences, Macquarie University, North Ryde, NSW, Australia.
The Institute for Musculoskeletal Health, Sydney Local Health District and the University of Sydney, Sydney, Australia.
Eur J Pain. 2022 Aug;26(7):1399-1411. doi: 10.1002/ejp.1974. Epub 2022 Jun 8.
Low back pain is common and remains one of the leading causes of disability globally. This study aimed to develop an evidence map of the quantity of available evidence assessing approaches to manage low back pain, to identify potential redundancies or gaps in the synthesized data, and guide future research focus.
MEDLINE, Embase, CENTRAL and CINAHL were searched to March 2022 for systematic reviews assessing the effectiveness of 10 guideline-recommended approaches to manage low back pain. For each management strategy, the number of systematic reviews, date of publication, eligibility criteria and included primary trials were extracted and descriptive data presented.
Substantial evidence, including both systematic reviews and primary trials, was available for each management approach except for patient reassurance. The quantity of available evidence has continued to increase over time. Cochrane reviews have been performed for all 10 treatments, except reassurance of the benign nature of low back pain; however, many of the Cochrane reviews were performed prior to 2015. Substantial heterogeneity in the eligibility criteria between systematic reviews exists; however, some age ranges (children and older adults), clinical settings (emergency), and conditions (radiculopathy) were infrequently assessed.
Based on systematic reviews, there is a large body of evidence assessing the effectiveness of common approaches to manage low back pain. Justification of the need for further systematic reviews and primary trials should consider the available evidence and is essential to avoid potential research redundancy when investigating effective management of low back pain.
Substantial evidence (systematic reviews and primary trials) exists for 10 approaches to manage low back pain. The quantity of available evidence has continued to increase over time. The quantity and large heterogeneity of inclusion criteria in available systematic reviews may influence conflicting recommendations in clinical practice guidelines. Justification of the need for further systematic reviews and primary trials is essential to avoid potential research redundancy.
腰痛较为常见，且仍是全球导致残疾的主要原因之一。本研究旨在制定一个腰痛管理方法相关证据图谱，以确定综合数据中是否存在潜在的冗余或空白，并为未来的研究重点提供指导。
检索 MEDLINE、Embase、CENTRAL 和 CINAHL，以获取截至 2022 年 3 月评估 10 项指南推荐的腰痛管理方法有效性的系统评价。对于每种管理策略，提取系统评价数量、发表日期、纳入标准和纳入的原始试验，并呈现描述性数据。
除患者安抚外，每种管理方法都有大量证据，包括系统评价和原始试验。随着时间的推移，可用证据的数量不断增加。除了对腰痛良性本质的安抚外，所有 10 种治疗方法都进行了 Cochrane 评价；然而，许多 Cochrane 评价都是在 2015 年之前进行的。系统评价之间的纳入标准存在很大的异质性；然而，一些年龄范围（儿童和老年人）、临床环境（急诊）和疾病（神经根病）很少被评估。
基于系统评价，有大量证据评估了常见腰痛管理方法的有效性。进一步进行系统评价和原始试验的必要性应考虑现有证据，这对于在调查腰痛有效管理时避免潜在的研究重复至关重要。
有大量证据（系统评价和原始试验）可用于 10 种腰痛管理方法。随着时间的推移，可用证据的数量不断增加。现有系统评价中纳入标准的数量和大量异质性可能会影响临床实践指南中的相互矛盾的建议。有必要对进一步进行系统评价和原始试验的必要性进行论证，以避免潜在的研究重复。
