Lim Ting Ho, Mak Hui Yeung, Man Ngai See Moriah, Man Yeuk Tsin, Tang Ching Ho, Wong Arnold Y L, Bussières André, Al Zoubi Fadi M
J Orthop Sports Phys Ther. 2025 Jan;55(1):12-25. doi: 10.2519/jospt.2024.12729.
To summarize the content and critically appraise the quality and applicability of recent clinical practice guidelines (CPGs) for nonpharmacological, nonsurgical management of spine pain. Systematic review of CPGs. Six databases and seven guideline clearinghouses. Included de novo CPGs for nonpharmacological, nonsurgical management of spine pain designed for any primary health care providers, published in English, Arabic, French, or traditional Chinese within the past 12 years. Five reviewers independently appraised the guidelines using AGREE II and AGREE-REX. Interrater agreements were calculated for each domain and the total score of these tools using the intraclass correlation coefficient (2, 1) with absolute agreement. We included 30 CPGs, primarily (90%) developed in Western countries, which contained 404 recommendations. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization/manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive (eg, corsets and orthosis) devices or electro/thermotherapies (eg, therapeutic ultrasound and transcutaneous electrical nerve stimulation). Approximately half of the CPGs demonstrated good methodological quality according to AGREE II, whereas the rest were of poor quality. On the AGREE-REX assessment, one third of the recommendations were of excellent quality. Although recent guidelines frequently recommended exercise therapy and multimodal care for the management of spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and considerations of knowledge users' values. .
总结近期关于脊柱疼痛非药物、非手术管理的临床实践指南（CPG）的内容，并严格评估其质量和适用性。对CPG进行系统评价。检索六个数据库和七个指南信息中心。纳入过去12年内以英文、阿拉伯文、法文或繁体中文发表的、为任何初级卫生保健提供者设计的关于脊柱疼痛非药物、非手术管理的全新CPG。五名评审员使用AGREE II和AGREE-REX独立评估这些指南。使用组内相关系数（2,1）计算这些工具每个领域的评分者间一致性及总分，一致性为绝对一致性。我们纳入了30份CPG，主要（90%）由西方国家制定，其中包含404条推荐意见。高质量的CPG一直推荐运动疗法和多模式护理，包括运动、松动术/手法治疗、教育、替代医学和认知行为治疗的组合。一般来说，CPG不推荐辅助设备（如束腹带和矫形器）或电/热疗法（如治疗性超声和经皮电刺激神经疗法）。根据AGREE II，约一半的CPG显示出良好的方法学质量，其余质量较差。在AGREE-REX评估中，三分之一的推荐意见质量优秀。尽管近期指南经常推荐运动疗法和多模式护理来管理脊柱疼痛，但它们的推荐意见往往忽视了人口统计学特征和合并症。尽管方法学有所改进，但大多数CPG缺乏简单的临床适用性，也未考虑知识使用者的价值观。
