Postsurgical rehabilitation for adults with low back pain with or without radiculopathy who were treated surgically: protocol for a mixed studies systematic review

Abstract

IntroductionSurgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients’ experiences with these interventions.ObjectivesTo conduct a mixed studies systematic review of quantitative and qualitative studies regarding: (1) the effectiveness and safety of postsurgical rehabilitation interventions for adults with LBP treated surgically and (2) the experiences of patients, healthcare providers, caregivers or others involved with the rehabilitation.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and the Rehabilitation & Sports Medicine Source for peer-reviewed empirical studies published from inception in any language. Studies using quantitative, qualitative and mixed methodologies will be included. We will also search reference lists of all eligible articles. Data extraction will include type of presurgical pathology, indication for surgery, surgical procedure, how the intervention was delivered and by whom, context and setting. We will conduct a quality assessment of each study and consider study quality in our evidence synthesis. We will use a sequential approach at the review level to synthesise and integrate data. First, we will synthesise the quantitative and qualitative studies independently, conducting a meta-analysis of the quantitative studies if appropriate and thematic synthesis of the qualitative studies. Then, we will integrate the quantitative and qualitative evidence by juxtaposing the findings in a matrix.Ethics and disseminationEthical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) presentations at national and international conferences and scientific meetings; (2) presentations to local and international stakeholders; (3) publications in peer-reviewed journals and (4) posts on organisational websites.PROSPERO registration numberCRD42019134607.

Rehabilitative management of back pain in children: protocol for a mixed studies systematic review

“…We developed this systematic review protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) 17 (see online supplemental additional file 1) and using methods already reported in detail elsewhere. 18 We registered our protocol on the International Prospective Register of Systematic Reviews (PROSPERO). 19 We will report our systematic review according to the PRISMA statement, 20 and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research reporting guideline.…”

“…26 Various healthcare providers may provide interventions including, but not limited to, general practitioners, nurses, physiotherapists, chiropractors, occupational therapists, psychologists and registered massage therapists (table 1). 18 We will exclude studies assessing surgical interventions, and interventions solely conducted at the societal level, such as barrier removal initiatives (eg, fitting a ramp to a public building).…”

“…We will critically appraise studies according to study design using appropriate checklists (see online supplemental additional file 3) (as described in detail previously). 18 We will assess the quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomised controlled trials (RCTs), cohort and case-control studies 49 ; the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for qualitative studies 50 ; the Mixed Methods Appraisal Tool (MMAT) for mixed-methods studies 51 and the Drummond checklist for economic evaluations. 52 The SIGN checklists allow reviewers to assess internal validity by considering the impact of selection bias, information bias and confounding on study results.…”

“…We will assess clinical, methodological and statistical heterogeneity among studies (as described in detail previously). 18 Differences in populations, interventions, comparators or outcomes across studies may result in clinical heterogeneity. Methodological and statistical heterogeneity may result from differences in risk of bias and differences in outcomes across studies beyond what could be expected by chance alone.…”

“…57 For example, we may list themes from the qualitative synthesis along one side of the matrix, and then plot the interventions evaluated in the quantitative synthesis against the themes as either a match (when the intervention matched a theme) or a mismatch (when the intervention was the opposite of a theme) (as described in detail previously). 18 We will also plot the economic evaluation findings against the corresponding intervention and theme. We will identify gaps in knowledge if a particular theme for an intervention does not match with any of the interventions evaluated in the quantitative studies.…”