What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 1: A synthesis of recommendation

Abstract

Background: Despite the emergence of multiple clinical practice guidelines (CPGs) for the rehabilitation of low back pain (LBP) over the last decade, self-reported levels of disability in this population have not improved. This may be explained by the numerous implementation barriers, such as the complexity of information and sheer volumes of CPGs. Objectives:The purpose of this study was to summarize the evidence and recommendations from the most recent and high-quality CPGs on the rehabilitation management of LBP by developing an infographic summarizing the recommendations to facilitate dissemination into clinical practice. Methods:We performed a systematic review of high-quality CPGs with an emphasis on rehabilitation approaches. We searched major health-related research databases (e.g., PubMed, CINAHL, and PEDro). We performed quality assessment via the AGREE-II instrument. Contents of the CPGs were synthesized by extracting recommendations, which were then compared to one another to identify consistencies based on an iterative evaluation process. Results:We identified and assessed 5 recent high-quality CPGs. We synthesized 13 recommendations on the rehabilitation management of LBP (2 for screening procedures, 3 for assessment procedures, and 8 involving treatment approaches) and 2 underlying principles were highlighted. These results were then synthetized and illustrated in a concise infographic that serves as a conceptual roadmap that identifies the specific behavior changes (i.e., adoption of CPGs' recommendations) rehabilitation professionals should adopt in order to integrate an evidenced-based approach for the management of LBP. Conclusions:We systematically reviewed the literature for CPGs' recommendations for the physical rehabilitation management of LBP and synthesized the information through an infographic.

Improving adherence to acute low back pain guideline recommendations with chiropractors and physiotherapists: the ALIGN cluster randomised controlled trial

“…Although the main recommendations in the guideline we implemented in this study are still current, that is avoiding routine imaging and giving advice to stay active, more recent low back pain guidelines have an increased focus on self-management, addressing psychosocial issues, and stratified care [ 16 – 18 ]. Implementation of more recent guideline recommendations for the management of low back pain likely require more complex models of care [ 2 , 53 ] and may need different tailored implementation approaches to those we tested [ 54 , 55 ].…”

“…Although this Australian guideline is now out of date, these recommendations remain current with more recent international guidelines for low back pain continuing to support these recommendations [ 13 – 15 ]. In addition to these recommendations, more recent guidelines have an increased focus on self-management, addressing the psychosocial issues of managing pain, and recommend stratified care approaches [ 16 – 18 ]. Successful implementation of guideline recommendations into clinical practice could improve outcomes for people with low back pain presenting to primary care providers (i.e.…”

Evidenzbasiertes und individualisiertes Training für Schmerzpatient*innen

“…Fast mantraartig weisen die Leitlinien darauf hin, dass Schmerzpatient*innen körperlich aktiver sein sollten, um eine Chronifizierung zu verhindern bzw. primär chronische Beschwerden zu therapieren [33,45,46,112] Unserem zeitgemäßen Verständnis entsprechend wird Schmerz nicht mehr eindimensional biomedizinisch erklärt, sondern als persönliche Erfahrung verstanden, die in unterschiedlichem Maße von biologischen, psychologischen und sozialen Faktoren beeinflusst wird [65]. Dementsprechend lassen sich das individuelle Assessment und die patientenzentrierte Behandlung der mehrdimensionalen Hintergrundfaktoren (Treiber) von Schmerz und Funktionsverlusten als kleinster gemeinsamer Nenner vieler vermeintlich unterschiedlicher Therapieansätze definieren [20, 66 -70].…”

“…Fast mantraartig weisen die Leitlinien darauf hin, dass Schmerzpatient*innen körperlich aktiver sein sollten, um eine Chronifizierung zu verhindern bzw. primär chronische Beschwerden zu therapieren 33 , 45 , 46 , 112 . Ungeachtet dessen reagieren Patient*innen hinsichtlich körperlicher Aktivität sehr variabel auf ein Schmerzerleben.…”

Observation of curative effect on meridian theory-based extracorporeal shock wave therapy for non-specific low back pain: study protocol for a randomized controlled trial

“…The main purpose of clinical treatment of NLBP is to relieve pain and improve the quality of life of patients. There are many clinical treatments for NLBP, including conservative therapy and surgery [ 9 – 11 ]. Conservative therapy including bed rest, drug therapy, physical exercise, and exercise therapy can relieve NLBP to a certain extent, but there are also many drawbacks; Surgical treatment is accompanied by problems such as postoperative infection and poor long-term efficacy, and the high cost brings a heavy economic burden to patients [ 12 ].…”