Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series

Abstract

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommendations derived from our conducted systematic reviews, offering practical guidance for conducting robust research on the effectiveness of rehabilitation interventions for CPLBP. Our systematic reviews contributed to the development of a WHO clinical guideline for CPLBP. Based on our experience, we have identified methodological issues and recommendations, which are compiled in a comprehensive table and discussed systematically within established frameworks for reporting and critically appraising RCTs. In conclusion, embracing the complexity of CPLBP involves recognizing its multifactorial nature and diverse contexts and planning for varying treatment responses. By embracing this complexity and emphasizing methodological rigor, research in the field can be improved, potentially leading to better care and outcomes for individuals with CPLBP.

Rehabilitation of back pain in the pediatric population: a mixed studies systematic review

“…This challenge is due to the nature of rehabilitation interventions. To minimize potential biases caused by these issues, future RCTs can be restricted to participants who are naïve to the studies interventions [ 31 ]. Alternatively, future RCTs can consider measuring treatment credibility/expectancy and blinding, and consider these in the analysis and interpretation of potential biases and the implications on intervention effect estimates [ 31 ].…”

“…To minimize potential biases caused by these issues, future RCTs can be restricted to participants who are naïve to the studies interventions [ 31 ]. Alternatively, future RCTs can consider measuring treatment credibility/expectancy and blinding, and consider these in the analysis and interpretation of potential biases and the implications on intervention effect estimates [ 31 ]. Furthermore, apart from RCTs, future studies can consider various study designs (e.g., quasi-experimental design, qualitative, mixed methods, and implementation studies) depending on the research question [ 31 ].…”

“…Alternatively, future RCTs can consider measuring treatment credibility/expectancy and blinding, and consider these in the analysis and interpretation of potential biases and the implications on intervention effect estimates [ 31 ]. Furthermore, apart from RCTs, future studies can consider various study designs (e.g., quasi-experimental design, qualitative, mixed methods, and implementation studies) depending on the research question [ 31 ]. These study designs can complement the evidence obtained from RCTs, therefore contributing to a more holistic perspective on the evaluation of benefits and harms, specifically for a context-sensitive condition (e.g., LBP).…”

“…We applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence for each outcome (Table 4 ) [ 30 ]. Recognizing the unique challenges of rehabilitation research, we adapted our application of GRADE to emphasize a context-sensitive analysis across five key domains: risk of bias, imprecision, publication bias, inconsistency, and indirectness, as suggested by Cancelliere et al (2023) [ 31 ]: 1.Risk of Bias: We assessed the risk of bias in individual studies, understanding that the internal validity of studies is crucial for confidence in our findings. High-quality (low risk of bias) studies were prioritized to ensure the credibility of our evidence synthesis.…”