Advice for acute low back pain: A comparison of what research supports and what guidelines recommend

Publication date: Available online 13 July 2017
Source:The Spine Journal
Author(s): Matthew L. Stevens, Chung-Wei C. Lin, Flavia A. de Carvalho, Kevin Phan, Bart Koes, Chris G. Maher
BackgroundAdvice is widely considered an effective treatment for acute low back pain (LBP) however details on what and how to deliver this intervention is less clear.PurposeWe assessed and compared clinical trials which test advice for acute LBP to practice guidelines for their completeness of reporting and concordance on the content, method of delivery and treatment regimen of advice interventions.Study Design/SettingSystematic ReviewMethodsAdvice RCTs were identified through a systematic search. Guidelines were taken from recent overviews of guidelines for LBP. Completeness of reporting was assessed using the TIDieR Checklist. Thematic analysis was used to characterise advice interventions into topics across the aspects of content, method of delivery and regimen. Concordance between clinical trials and guidelines was assessed by comparing the number of trials that found a statistically significant treatment effect for an intervention that included a specific advice topic against the number of guidelines recommending that topic.ResultsThe Median (IQR) completeness of reporting for clinical trials and guidelines was 8 (7-9) and 3 (2-4) out of 9 items on the TIDieR Checklist, respectively. Guideline recommendations were discordant with clinical trials for 50% of the advice topics identified.ConclusionCompleteness of reporting was less than ideal for RCTs and extremely poor for guidelines. The recommendations made in guidelines of advice for acute LBP were often not concordant with the results of clinical trials. Taken together these findings mean that the potential clinical value of advice interventions for patients with acute LBP is probably not being realised.



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