OBJECTIVE: To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR).
DATA SOURCE: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Services Economic Evaluation Database, Health Technology Assessment Database, PEDro, the Trip Database, the Index to Chiropractic Literature and the gray literature.
STUDY SELECTION: Eligible guidelines were (1) published between 2009 and 2019 in English, French, Italian, or Swedish; (2) included adults or children with non-specific LBP with or without radiculopathy; and (3) assessed the benefits of rehabilitation interventions on functioning. Pairs of independent reviewers assessed the quality of the CPGs using AGREE II.
DATA SYNTHESIS: We identified 4 high-quality CPGs. Recommended interventions included (1) education about recovery expectations, self-management strategies, and maintenance of usual activities; (2) multimodal approaches incorporating education, exercise, and spinal manipulation; (3) nonsteroidal anti-inflammatory drugs combined with education in the acute stage; and (4) intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain. We did not identify high-quality CPGs for people younger than 16 years of age.
CONCLUSION: We developed evidence-based recommendations from high-quality CPGs to inform the WHO PIR for people with LBP with and without radiculopathy. These recommendations emphasize the potential benefits of education, exercise, manual therapy, and cognitive/behavioral interventions.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician |  |
Physician rater
This revision of CPGs is marked by the tendency to prioritize function recovery (rehabilitation) rather than pain. Needless to say, nociplastic pain has an important role in the broad LBP population with/without radiculopathy.
Physician rater
A state-of-the-art review showing no changes in the state-of-the-art.
Physician rater
Good analysis of the date and info and summation of therapies.
Rehab Clinician (OT/PT) rater
This study highlights clearly the benefits of education, exercise, and multimodal care that includes manual therapies. However, the use of most passive modalities is not recommended.
Rehab Clinician (OT/PT) rater
The identification of best evidence for persons with non-specific low back pain with and without radiculopathy is thoroughly searched and the four outcomes are clearly described. It is useful for all practitioners to know. Especially, so for the education and support to continue, and for specific interventions for the relevant professionals.
Rehab Clinician (OT/PT) rater
Well written systematic review in that it compares the levels of evidence across different treatment modalities and presentation of symptoms.
Rehab Clinician (OT/PT) rater
This was a very interesting, unique, and clinical applicable systematic review of available CPG's on the topic of LBP, including both with and without radiculopathy. The resulting synthesis of available information will help clinicians such as myself continue to leverage best available research evidence and integrate into clinical practice when treating clients with this problem.
, McMaster University