ObjectiveTo appraise the quality of low back pain (LBP) clinical practice guidelines (CPG) that include interventional management recommendations and to associate their quality with characteristics including publication year and creating organization.TypeSystematic Review.Literature SurveyLBP (subacute or chronic) CPGs in English (symptom based, governmental or professional society created, January 1990‐May 2020) were found using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, ECRI, Guidelines International Network, NICE, and SIGN.MethodologyIn this third order systematic review, search results were deduplicated, title and abstract screened by two independent reviewers, and full texts reviewed by four reviewers. Discrepancies were resolved by a third reviewer. Resulted CPGs were appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool by four appraisers each. Association of their quality with creating organization, geographical region, and year of creation was calculated.SynthesisSeven hundred fourteen screened documents resulted in 21 final CPGs. On appraisal, average overall CPG quality was 5.2 (range 2.5‐6.75). Domain 5 (applicability) had the lowest average (44%) and domain 4 (clarity of presentation) had the highest average score (82%). For overall recommendation, 16 received “yes” or “yes with modifications,” six received unanimous “yes” and two unanimous “no” votes. The interrater agreement of domain scoring was excellent (0.8‐1.0; p < .001). There was no association found between quality of CPG and (1) year of publication (R2 = 0.0006), (2) whether the CPG was updated or new (p = .17), and (3) region of publication (p = .37).ConclusionsThe majority of the 21 CPGs identified in this systematic review were of high quality, but overall quality and recommendation ratings were variable. The quality of appraised CPGs showed no association with their characteristics. Some domains such as “applicability” scored uniformly lower, revealing opportunity for improvement in future CPG development. LBP CPGs should be scrutinized before adopting their recommendations.

ObjectiveTo summarize the recommendations on the interventional management of subacute and chronic non‐radicular low back pain (LBP) from the 21 quality‐appraised CPGs identified in the previously published paper: “Quality of Clinical Practice Guidelines on Interventional Management of Low Back Pain: A Systematic Review”. By disseminating this information, we aim to facilitate the implementation of these recommendations into clinical practice.Literature SurveyElectronic bibliographic databases, guideline databases and grey literature were searched from January 2016 to January 2020 to identify CPGs that met study criteria.Methodology21 CPGs were quality‐appraised and interventional management recommendations were extracted and organized into several treatment categories including epidural steroid injections (ESIs), radiofrequency procedures (RF), facet injections, sacroiliac injections (SI), and prolotherapy. Within each treatment category, the recommendations were organized based on 2 factors: quality of CPG and strength of recommendation.SynthesisOverall, there was no consistency in recommendations for or against any interventional procedure, even when accounting for the quality of the CPG. In all of the CPGs reviewed, the most common strength of recommendation was weakly‐for. The second, third and fourth most common strength of recommendations were inconclusive, weakly‐against and strongly‐against respectively and the least common was strongly‐for. The treatment categories with the greatest number of recommendations were RF procedures (most common strength of recommendation‐weakly for) and facet procedures. Among the high‐quality CPGs, the most common strength of recommendation was inconclusive.ConclusionsMost of the interventional management recommendations for management of non‐radicular LBP in the 21 CPGs appraised in this review were either weakly‐for, weakly‐against or inconclusive, with several recommendations within each treatment category contradicting each other. AGREE II quality appraisals of CPGs on interventional management of LBP were of unclear utility in guiding clinical implementation.

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