The Belgian national guideline on low back pain and radicular pain: key roles for rehabilitation, assessment of rehabilitation potential and the PRM specialist

Wambeke, Peter Van; Desomer, Anja; Jonckheer, Pascale; Depreitere, Bart

doi:10.23736/s1973-9087.19.05983-5

Cited by 47 publications

(108 citation statements)

References 21 publications

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“…The NICE guideline [ 51 ] had the highest quality (96%) in the area of Educational/behavioural, physical therapy, pharmaceutical interventions. The Belgian Healthcare Knowledge Centre (KCE) (83%) guideline [ 56 ] had high quality and covered the same interventions plus surgery with a short time span (1 and 2 years, respectively) for searching evidence (Supplementary Digital Content 3 ).…”

Section: Resultsmentioning

confidence: 99%

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Castellini

Iannicelli

Briguglio

et al. 2020

BMC Health Serv Res

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Background Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. Methods Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. Results A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31–84%), Scope and Purpose (median 64%, IQR 22–83%), Rigour of Development (median 50%, IQR 21–72%), Clarity and Presentation (median 50%, IQR 28–79%), Stakeholder Involvement (median 36%, IQR 10–74%), and Applicability (median 11%, IQR 0–46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88–0.91). The median time span was 2 years (range, 1–4), however, 38% of the CPGs did not report the coverage dates for systematic searches. Conclusions We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

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Section: Resultsmentioning

confidence: 99%

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Castellini

Iannicelli

Briguglio

et al. 2020

BMC Health Serv Res

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“…Although the PACE Plus trial was terminated as a result of insufficient patient inclusion, the research questions addressed in this trial remain relevant but unanswered. This is especially true in light of recent international LBP guidelines [ 14 – 17 ], in which the use of any medication for LBP is discouraged. Lessons learned from the discontinuation of PACE Plus and corresponding recommendations have been summarized in Table 4 .…”

Section: Discussionmentioning

confidence: 99%

Discontinuation of the PACE Plus trial: problems in patient recruitment in general practice

Schreijenberg

Luijsterburg

Trier

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe PACE Plus trial was a multi-center, double-blinded, superiority randomized controlled trial (RCT) conducted in patients from Dutch general practice to investigate the efficacy of paracetamol and NSAIDs in acute non-specific low back pain (LBP). Because insufficient numbers of patients could be recruited (only four out of the required 800 patients could be recruited over a period of 6 months), the trial was prematurely terminated in February 2017, 6 months after the start of recruitment. This article aims to transparently communicate the discontinuation of PACE Plus and to make recommendations for future studies.MethodsGeneral Practitioners (GPs) from 36 participating practices received a one-question survey in which they were asked to give the three most important factors that in their opinion contributed to failure of patient recruitment.ResultsGPs of 33 out of 36 (92%) participating practices sent a response. A total of 81 factors were reported. These have been categorized into patient factors (26 out of 81 comments, 32%), GP factors (39 out of 81 comments, 48%) and research factors (16 out of 81 comments, 20%).DiscussionPatient recruitment in the PACE Plus trial may have failed due to inefficient medication distribution, recruitment of incident rather than prevalent cases, a design that was too complicated, adequate self-management of LBP, patient expectations different from the trial’s scope and lack of time of participating GPs. Substantial differences in design may explain why the preceding PACE trial did manage to successfully complete patient recruitment.ConclusionAlthough the PACE Plus trial was terminated as a result of insufficient patient inclusion, the research questions addressed in this trial remain relevant but unanswered. We hope that lessons learned from the discontinuation of PACE Plus and corresponding recommendations may be helpful in the design of upcoming research projects in LBP in general practice.Trial registrationDutch Trial Registration NTR6089, registered September 14th 2016.

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“…[32] For opioids, clinicians must carefully consider before using and only use these drugs in the short to medium term when other therapies have been insu cient. [31,33] Low back pain Assessment Clinicians were recommended to systematically collect formal histories [33,35,36,38,[41][42][43][44][45][46][47] and physical examinations, [33, 36, 38, 41-44, 46, 47] identifying serious pathology (i.e., red ags), [33,[36][37][38][41][42][43][44][45][46][47] and classifying acute, subacute and chronic pain, [33,35,38,[45][46][47] initially. Some CPGs also recommended that clinicians assess psychosocial factors [33,[36][37][38][39][40][41][42][43][44][45][46][47] such as STarT Back and Örebro questionnaires.…”

Section: Conduct Physical Examination and Assess Psychosocial Factorsmentioning

confidence: 99%

“…[33, 36-38, 42, 45, 47] Routine use of radiological imaging Nine CPGs were against routine use of radiological imaging for LBP. [36-39, 41, 42, 45-47] Imaging should be considered only if the results in uence the management method, [37,44,47] if there are clinical reasons to suspect serious underlying pathology (i.e., red ags) [36,38,39,41,[44][45][46] or if symptoms worsen after a period of formal treatment according to the guideline. [40,42,46] Provide education and exercise therapy Most CPGs recommended patient education [33,[36][37][38][39][40][41][42][43][45][46][47] (e.g., explaining the expected course, advising to remain active and providing information about self-management options) and exercise therapy [33,[35][36][37][38][39][40][41][42][43][45][46][47] as the rst-line choice for the management of acute, subacute and chronic low back pain.…”

Section: Conduct Physical Examination and Assess Psychosocial Factorsmentioning

confidence: 99%

“…[33] In addition, some guidelines suggested that manual therapy could be applied if self-care and medication therapy did not provide signi cant improvements [36] or that it could be offered as a part of multimodal management. [37,39,46,47] One CPG recommended massage for treating acute and subacute low back pain, [35] while two guidelines indicated that massage was not recommended for acute low back pain but could be considered for chronic low back pain. [40,41] One guideline stated that there was insu cient evidence to show the effect of manual therapy including massage.…”

Section: Manual Therapymentioning

confidence: 99%

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The Evidence Mapping and Methodological Quality of Clinical Practice Guidelines of Diagnosis and Management for Spinal Pain: A Cross-Sectional Study

Huang

Qin

Zheng

et al. 2021

Preprint

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Objectives: To systematically review clinical practice guidelines (CPGs) for treating spinal pain, to assess the quality of different CPGs, and finally to provide an evidence map for the specific explication of research trends and gaps.Method: We searched CPGs in PubMed, Embase, Web of Science, Guidelines International Network (GIN), National Health and Medical Research Council (NHMRC), Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE). We extracted basic information, recommendations, methodological quality, and reporting quality of the CPGs. Four researchers independently evaluated the quality of the CPGs according to the Appraisal of Guidelines Research and Evaluation (AGREE II) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Results: According to the AGREE II checklist, we found that the mean score was relatively high in four domains, namely, scope and purpose (78.39), stakeholder involvement (63.04), clarity of presentation (72.04), and rigor of development (61.25). However, the mean score of two domains (editorial independence and application) was relatively low. Among the seven domains of the RIGHT checklist, one field (basic information) had the highest reporting rate (86.61%), while another field (funding, declaration, and management of interest) obtained the lowest reporting rate (53.00%). Conclusion: Our study provided evidence mapping, which is a good tool to reduce research waste and facilitate the process of knowledge transfer. The results of our study can also be used to optimize the implementation of these recommendations and to improve the development of reliable CPGs for treating spinal pain.

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The Belgian national guideline on low back pain and radicular pain: key roles for rehabilitation, assessment of rehabilitation potential and the PRM specialist

Cited by 47 publications

References 21 publications

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument

Discontinuation of the PACE Plus trial: problems in patient recruitment in general practice

The Evidence Mapping and Methodological Quality of Clinical Practice Guidelines of Diagnosis and Management for Spinal Pain: A Cross-Sectional Study

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