An updated overview of clinical guidelines for the management of non-specific low back pain in primary care |
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Authors: | Bart W Koes Maurits van Tulder Chung-Wei Christine Lin Luciana G Macedo James McAuley Chris Maher |
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Institution: | (1) Department of General Practice, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;(2) Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands;(3) George Institute, Sydney, Australia |
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Abstract: | The aim of this study was to present and compare the content of (inter)national clinical guidelines for the management of
low back pain. To rationalise the management of low back pain, evidence-based clinical guidelines have been issued in many
countries. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines
to include more or less similar recommendations regarding diagnosis and treatment. We updated a previous review that included
clinical guidelines published up to and including the year 2000. Guidelines were included that met the following criteria:
the target group consisted mainly of primary health care professionals, and the guideline was published in English, German,
Finnish, Spanish, Norwegian, or Dutch. Only one guideline per country was included: the one most recently published. This
updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe
published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification
(diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were
the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial
factors as risk factors for chronicity. For chronic low back pain, consistent features included supervised exercises, cognitive
behavioural therapy and multidisciplinary treatment. However, there are some discrepancies for recommendations regarding spinal
manipulation and drug treatment for acute and chronic low back pain. The comparison of international clinical guidelines for
the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar. There are also
some differences which may be due to a lack of strong evidence regarding these topics or due to differences in local health
care systems. The implementation of these clinical guidelines remains a challenge for clinical practice and research. |
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Keywords: | Low back pain Clinical guidelines Review Diagnosis Treatment |
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