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

Lin, Ivan; Wiles, Louise; Waller, Robert R.; Goucke, Roger; Nagree, Yusuf; Gibberd, Michael; Straker, Leon; Maher, Christopher G.; O’Sullivan, Peter

doi:10.1136/bjsports-2017-098375

Cited by 67 publications

(74 citation statements)

References 63 publications

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“…In the remaining 4 domains, overall scores <40% were obtained. In detail, domain 2 “Stakeholder involvement” obtained an average score of 38.43%, mainly due to the lack of information about target population views and preferences (domain 2), as also addressed by Lin and colleagues regarding the evaluation of guidelines for musculoskeletal pain . The noninvolvement of relevant professional figures other than radiologists in guideline's draft except for ACR guideline (in which neurologists, surgeons, and nuclear medicine specialists were also involved) could also explain this finding along with the highest variability (SD 20.62%) found among guidelines’ scores in this domain.…”

Section: Discussionmentioning

confidence: 92%

“…In detail, domain 2 "Stakeholder involvement" obtained an average score of 38.43%, mainly due to the lack of information about target population views and preferences (domain 2), as also addressed by Lin and colleagues regarding the evaluation of guidelines for musculoskeletal pain. 25 The noninvolvement of relevant professional figures other than radiologists in guideline's draft except for ACR guideline (in which neurologists, surgeons, and nuclear medicine specialists were also involved) could also explain this finding along with the highest variability (SD 20.62%) found among guidelines' scores in this domain. Domain 3, "Rigor of development," scored an average percentage score of 33.85% since methods for searching or evaluating evidences were not always specified and no guideline authors' team applied the Delphi or Glaser technique to achieve a mutual agreement among experts.…”

Section: Discussionmentioning

confidence: 99%

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A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

et al. 2018

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BackgroundDiagnostic imaging guidelines are increasingly embraced in oncologic imaging in order to improve examinations appropriateness and technical quality. The usefulness of guidelines employment in clinical practice is dramatically related to the quality of the guidelines themselves. However, an extreme variability in guidelines’ quality may occur. Following a European Network for the Assessment of Imaging in Medicine (EuroAIM) initiative, the aim of this study was to assess the quality of the available guidelines regarding head and neck cancer (HNC) imaging.MethodsA literature search was conducted to identify imaging guidelines focused on HNC. Selected guidelines were evaluated by four independent appraisers using the Appraisal of Guidelines for Research & Evaluation version 2.0 (AGREE II) tool, which comprises 23 key items, rated on a 7‐point scale (1—strongly disagree to 7—strongly agree) and organized within six domains. For each domain, the intraclass correlation coefficient (ICC) was used to assess the agreement among appraisers’ scores.ResultsAfter literature search, three guidelines were selected and evaluated. One guideline scored “average” as overall quality, while the remaining two scored a “low” overall quality. The highest result (total score = 75.0% ± 19.3%) was obtained in domain 4 (Clarity of presentation) while the lowest (total score = 27.1% ± 4.2%) in domain 6 (Editorial independence). ICC analysis showed a very good agreement (range: 0.932‐0.961) among the four appraisers.ConclusionsOur results showed a heterogeneous quality of existing guidelines in HNC imaging. Issues raised from this appraisal should be considered when developing future guidelines on HNC imaging.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

et al. 2018

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“…Many systematic reviews have reported on the low quality of evidence concerning the relationship between musculoskeletal disease symptoms and physical activity level. Unfortunately, most studies have focused on generalized pain disorders including fibromyalgia and localized disorders of other body parts including the lower back, neck and shoulders . No study has considered the relationship between general physical activity level and TMD symptoms before, and this is the first attempt to define such an association.…”

Section: Discussionmentioning

confidence: 99%

Physical activity level and temporomandibular disorders in South Koreans

Cho

Kim

Park

et al. 2020

Comm Dent Oral Epid

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Objective: This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large-scale national database established through a nationwide survey. Methods: Data from the Fourth Korean National Health and Nutrition ExaminationSurvey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross-sectional study. Data on sociodemographic characteristics, TMD-related variables, and general physical activity level were collected. Participants were divided into moderate-and low-intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates. Results:The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017-1.854) for people doing moderate-intensity exercises and 0.797 (0.629-1.008) among people doing low-intensity exercises. Those who did moderateintensity exercises had significantly more TMD pain. This was higher in the 30-to 39-year age group (OR: 1.991, 95% CI: 1.137-3.488), with significantly higher risk for TMD pain in those who did moderate-intensity exercise, whereas low-intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409-0.958). Conclusions:Moderate-intensity physical activity is associated with more TMD pain.Patients with TMD should avoid high-intensity level exercises and continue low-intensity exercises to prevent pain aggravation. CHO et al. previous studies in terms of pain levels and disease duration. Some reports indicate that regular physical activity decreases pain, 9,10 but a few studies have suggested further pain aggravation with physical activity. 10 Exercise effectively reduces pain symptoms, even in patients with chronic pain disorders such as fibromyalgia and lower back pain. 11,12 However, clinical observations also suggest that many patients with musculoskeletal pain experience an increase in pain and fatigue during exercise or even while conducting simple daily activities. [13][14][15] Unfortunately, previous literature on the interaction between physical activity and musculoskeletal disease status has mostly focused on general chronic pain syndromes such as lower back pain and fibromyalgia, while papers concentrating on orofacial pain (including TMD) are scarce. The few studies concerning TMD have been limited to investigating the effects of specific exercises developed to relax the masticatory muscles and improve mandibular movement. |No study has investigated the association between general physical activity level and TMD symptoms. Since the patient's physical activity level could affect TMD pain severity, the relationship between the two should be examined in order to inform the development of accurate guidelines for prescribing exercise to patients with TMD and to prevent further damage from inappropriate levels of physical activity. Accordingly, this study investiga...

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“…Assessing the quality of general health information given in the AHG was found to be a complex task because there is little evidence available for the recommendations given. For example, it has recently been shown that clinical guidelines for musculo‐skeletal pain conditions in the general population are of inferior quality 39 . Nonetheless, in a society with virtually infinite access to information, it is of utmost importance that a sports organization take responsibility for the information conveyed to its members.…”

Section: Discussionmentioning

confidence: 99%

Developing web‐based health guidance for coaches and parents in child athletics (track and field)

Jacobsson

Ekberg

Timpka

et al. 2020

Scandinavian Med Sci Sports

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The aim of this study was to develop athletics health guidance (AHG) aimed at supporting coaches and parents involved in organized child athletics by providing practical advice and tools for the management of the most common health problems experienced in athletics by the 12‐ to 15‐year olds. The study used participatory action research (PAR) and an established health service guideline development procedure modified to fit AHG development in child athletics. A sequential process consisting of four steps with associated subgoals was employed. The collected data were structured according to the AHG development steps and analyzed using qualitative methods. The most common health concern identified was injuries related to growth and overuse. No randomized controlled studies investigating injury prevention programs or any existing concepts/guidelines in child athletics were found that could be used in the development of the AHG. A requirements document was instead defined in a nominal group process and used for the AHG development. The areas included in the final AHG were as follows: training youth athletes, growth and puberty, recovery, injury prevention, injuries and illnesses, mental illness, safe sport, and anti‐doping. The evidence regarding health issues in child athletics is limited, indicating that actions to support good health in the sport are currently based essentially on best practice. The long‐term aim of the AHG and associated website is to systematically create and introduce conditions that can bridge the "know‐do gap" and provide coaches and parents with easy‐to‐access and up‐to‐date knowledge in the field of child athlete health in athletics.

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

Abstract: Objectives Undertake 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.

Cited by 67 publications

References 63 publications

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

Physical activity level and temporomandibular disorders in South Koreans

Developing web‐based health guidance for coaches and parents in child athletics (track and field)

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