Quality of Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Systematic Review; Part 1

PM&R ◽  
2022 ◽  
Author(s):  
Timothy J. Olivier ◽  
Becky Baltich Nelson ◽  
Tri Pham ◽  
Kavita Trivedi ◽  
Ankit Patel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Low Back ◽  
Interventional Management

scholarly journals Are Clinical Practice Guidelines for Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

2020 ◽  
Author(s):  
Greta Castellini ◽  
Valerio Iannicelli ◽  
Matteo Briguglio ◽  
Davide Corbetta ◽  
Luca Maria Sconfienza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Grey Literature ◽  
Pharmacological Intervention ◽  
Low Back ◽  
Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded.METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches.CONCLUSIONS: We found methodological limitations that affect CPGs quality. A universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1REGISTRATION PROSPERO DETAILS: CRD42019127619.

scholarly journals Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

2017 ◽  
Vol 52 (5) ◽  
pp. 337-343 ◽  
Author(s):  
Ivan Lin ◽  
Louise K Wiles ◽  
Robert Waller ◽  
Roger Goucke ◽  
Yusuf Nagree ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Critical Appraisal ◽  
Low Back ◽  
Agree Ii ◽  
The Usa

ObjectivesUndertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.DesignSystematic review of CPGs (PROSPERO number: CRD42016051653).Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sources and method of appraisalFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.Results4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were for applicability (26%, SD=19.5) and editorial independence (33%, SD=27.5). The highest score was for scope and purpose (72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).

scholarly journals HOW GOOD ARE LOW BACK PAIN GUIDELINES? A CRITICAL APPRAISAL OF THE QUALITY OF CLINICAL PRACTICE GUIDELINES USING THE AGREE II TOOL

2020 ◽  
Author(s):  
Valerio Iannicelli ◽  
Greta Castellini ◽  
Matteo Briguglio ◽  
Davide Corbetta ◽  
Luca Maria Sconfienza ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Low Back ◽  
Agree Ii ◽  
National Systems ◽  
Back Pain Management

Clinical practice guidelines (CPGs) provide evidence-based recommendations for clinical practice, but their increasing number in the last few years arises possible concerns about their quality. Preliminary results on the methodological quality of CPGs for low back pain management (LBP) are here presented. The results of this review can help researchers and Italian policymakers select and adopt the highest quality Clinical Practice Guidelines (CPGs) for Low Back Pain (LBP) management in the CPG National Systems (Sistema Nazionale Linee Guida).

scholarly journals Are Clinical Practice Guidelines of Low Back Pain interventions of high quality and updated? A systematic review using the AGREE II instrument

2020 ◽  
Author(s):  
Greta Castellini ◽  
Valerio Iannicelli ◽  
Matteo Briguglio ◽  
Davide Corbetta ◽  
Luca Maria Sconfienza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Grey Literature ◽  
Pharmacological Intervention ◽  
Low Back ◽  
Agree Ii

Abstract BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. METHODS: Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. RESULTS: A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31 – 84%), Scope and Purpose (median 64%, IQR 22 – 83%), Rigour of Development (median 50%, IQR 21 – 72%), Clarity and Presentation (median 50%, IQR 28 – 79%), Stakeholder Involvement (median 36%, IQR 10 – 74%), and Applicability (median 11%, IQR 0 – 46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88 – 0.91). The median time span was 2 years (range, 1-4), however, 38% of the CPGs did not report the coverage dates for systematic searches. CONCLUSIONS: We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. LEVEL OF EVIDENCE: 1 REGISTRATION PROSPERO DETAILS: CRD42019127619.

scholarly journals Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
G. Castellini ◽  
V. Iannicelli ◽  
M. Briguglio ◽  
D. Corbetta ◽  
L. M. Sconfienza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Grey Literature ◽  
Pharmacological Intervention ◽  
Low Back ◽  
Agree Ii

Abstract Background Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. Methods Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. Results A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31–84%), Scope and Purpose (median 64%, IQR 22–83%), Rigour of Development (median 50%, IQR 21–72%), Clarity and Presentation (median 50%, IQR 28–79%), Stakeholder Involvement (median 36%, IQR 10–74%), and Applicability (median 11%, IQR 0–46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88–0.91). The median time span was 2 years (range, 1–4), however, 38% of the CPGs did not report the coverage dates for systematic searches. Conclusions We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

scholarly journals Red flag screening for low back pain: nothing to see here, move along: a narrative review

2017 ◽  
Vol 52 (8) ◽  
pp. 493-496 ◽  
Author(s):  
Chad E Cook ◽  
Steven Z George ◽  
Michael P Reiman
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Negative Likelihood Ratio ◽  
Low Back ◽  
Red Flags ◽  
Red Flag

Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. We share four major reasons why red flag screening is not consistent with best practice in LBP management: (1) clinicians do not actually screen for red flags, they manage the findings; (2) red flag symptomology negates the utility of clinical findings; (3) the tests lack the negative likelihood ratio to serve as a screen; and (4) clinical practice guidelines do not include specific processes that aid decision-making. Based on these findings, we propose that clinicians consider: (1) the importance of watchful waiting; (2) the value-based care does not support clinical examination driven by red flag symptoms; and (3) the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.

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