MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK.
Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK.
BMC Musculoskelet Disord. 2024 May 1;25(1):344. doi: 10.1186/s12891-024-07468-0.
Low back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world.
MEDLINE, EMBASE, CINAHL, PEDro, and major guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
Our analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture.
Current CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the guidelines.
下腰痛（LBP）是全球范围内一个严重的健康问题，在普通成年人群中的终身患病率为 84%。为了合理管理 LBP，世界各地已发布了临床实践指南（CPG）。本研究旨在确定并比较全球范围内最近的 LBP 管理 CPG 的建议。
从 2017 年到 2022 年，我们在 MEDLINE、EMBASE、CINAHL、PEDro 和主要指南数据库中进行了搜索，以确定 CPG。符合纳入标准的 CPG 是指专注于非特异性 LBP 管理和/或治疗相关信息的指南。使用评估指南研究与评估（AGREE II）工具评估纳入指南的质量。
我们的分析共确定了 22 项符合纳入标准的 CPG，这些 CPG 在 AGREE II 工具评估中具有中到高的方法学质量。这些指南的建议存在异质性，特别是在 LBP 不同阶段的处理方法上。对于急性 LBP，指南建议使用非甾体抗炎药（NSAIDs）、治疗性运动、保持活动和脊柱手法治疗。对于亚急性 LBP，指南建议使用 NSAIDs、治疗性运动、保持活动和脊柱手法治疗。对于慢性 LBP，指南建议使用治疗性运动、NSAIDs、脊柱手法治疗和针灸。
目前的 CPG 提供了几乎所有 LBP 管理的主要方面的建议，但它们之间存在显著的异质性。一些建议缺乏清晰度，与指南内的其他治疗方法重叠。
