PAIN+ CPN

OBJECTIVE: To summarize the content and critically appraise the quality and applicability of recent clinical practice guidelines (CPGs) for nonpharmacological, nonsurgical management of spine pain. DESIGN: Systematic review of CPGs. LITERATURE SEARCH: Six databases and seven guideline clearinghouses. STUDY SELECTION CRITERIA: Included de novo CPGs for nonpharmacological, nonsurgical management of spine pain designed for any primary health care providers, published in English, Arabic, French, or traditional Chinese within the past 12 years. DATA SYNTHESIS: Five reviewers independently appraised the guidelines using AGREE II and AGREE-REX. Interrater agreements were calculated for each domain and the total score of these tools using the intraclass correlation coefficient (2, 1) with absolute agreement. RESULTS: We included 30 CPGs, primarily (90%) developed in Western countries, which contained 404 recommendations. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization/manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive (eg, corsets and orthosis) devices or electro/thermotherapies (eg, therapeutic ultrasound and transcutaneous electrical nerve stimulation). Approximately half of the CPGs demonstrated good methodological quality according to AGREE II, whereas the rest were of poor quality. On the AGREE-REX assessment, one third of the recommendations were of excellent quality. CONCLUSION: Although recent guidelines frequently recommended exercise therapy and multimodal care for the management of spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and considerations of knowledge users' values. J Orthop Sports Phys Ther 2025;55(1):1-14. Epub 4 November 2024. doi:10.2519/jospt.2024.12729.

Physician rater

This study using AGREE II and AGREE-REX tools showed the inconsistencies associated with non-surgical treatment for spine pain and the high variation in recommendations and method of application for different patient groups.

Physician rater

This systematic review summarized the content and critically appraised the quality and applicability of recent clinical practice guidelines (CPGs) for nonpharmacological nonsurgical management of spine pain. Thirty CPGs were included. High-quality CPGs consistently recommended exercise therapy and multimodal care, encompassing a combination of exercises, mobilization-manipulation, education, alternative medicine, and cognitive-behavioral treatments. Generally, CPGs did not recommend assistive devices (eg, corsets and orthosis) or electro-thermotherapies. Approximately half of the CPGs demonstrated good methodological quality according to AGREE II. Although recent guidelines frequently recommended exercise therapy and multimodal care for managing spine pain, their recommendations often overlooked demographics and comorbidities. Despite methodological improvements, most CPGs lacked simple clinical applicability and consideration of users’ values.

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