A Review of Clinical Practice Guidelines for Physiotherapy Management of Patients with Non-Specific Low Back Pain
DOI:
https://doi.org/10.55489/njcm.150520243849Keywords:
Non-specific low back pain, Clinical practice guidelines, Physiotherapy, Cognitive behavioural therapy, BiopsychosocialAbstract
Background: Despite the availability of various clinical practice guidelines (CPGs) offering evidence-based recommendations, there exists a global diversity in physiotherapy practices for managing patients with non-specific low back pain (NSLBP). In this review, we aim to critically appraise and map the current evidence regarding physiotherapy management for patients with NSLBP.
Methods: A search strategy was formulated and searched in MEDLINE, Scopus, EBSCOhost, PEDro and Google Scholar between 2013 and 2023 in English. Critical appraisal was performed using International Centre for Allied Health Evidence (iCAHE) guideline checklist.
Results: A total of 12 CPGs met the selection criteria were synthesised. Exercise therapy, physical activity and manual therapy were consistently recommended for patients with NSLBP across most guidelines, irrespective of symptom duration. Cognitive-behavioural therapy was frequently advised for those with chronic NSLBP. However, notable absences of recommendations for electrotherapy, mechanical traction, bed rest, and lumbar corsets in NSLBP management. Moreover, emerging treatments such as shock wave therapy and cognitive-functional therapy were not extensively addressed in the guidelines.
Conclusion: Multimodal and active forms of physiotherapy management were predominantly recommended in most of the guidelines. However, there is a clear necessity for updated CPG that effectively integrate biopsychosocial approaches into the management of patients with NSLBP.
References
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006-17. Doi: https://doi.org/10.1016/S0140-6736(20)32340-0 PMid:33275908
Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):1-14. Doi: https://doi.org/10.21037/atm.2020.02.175 PMid:32355743 PMCid:PMC7186678
Almeida MO, Narciso Garcia A, Menezes Costa LC, van Tulder MW, Lin CW, Machado LAC. The mckenzie method for (sub)acute non‐specific low back pain. Cochrane Database of Systematic Reviews. 2023(4):1-3. Doi: https://doi.org/10.1002/14651858.CD009711.pub2 PMid:37017272 PMCid:PMC10076480
De Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo AS, Pereira CAB, et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo). 2019;74:e789. Doi: https://doi.org/10.6061/clinics/2019/e789 PMid:31664424 PMCid:PMC6807687
Robalo L. Epidemiology of Non-Specific Back Pain in Children and Adolescents: a Systematic Review of Observational Studies. Journal of Novel Physiotherapies. 2015(05):1-8. Doi: https://doi.org/10.4172/2165-7025.1000266
Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803. Doi: https://doi.org/10.1007/s00586-018-5673-2 PMid:29971708
Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice G. In: Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, editors. Clinical Practice Guidelines We Can Trust. Washington (DC): National Academies Press (US) Copyright 2011 by the National Academy of Sciences. All rights reserved.; 2011. Doi: https://doi.org/10.17226/13058
Castellini G, Iannicelli V, Briguglio M, Corbetta D, Sconfienza LM, Banfi G, et al. Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument. BMC Health Services Research. 2020;20(1):1-10. Doi: https://doi.org/10.1186/s12913-020-05827-w PMid:33092579 PMCid:PMC7583191
Bironzo P, Di Maio M. A review of guidelines for lung cancer. J Thorac Dis. 2018;10(Suppl 13):1556-63. Doi: https://doi.org/10.21037/jtd.2018.03.54 PMid:29951306 PMCid:PMC5994504
Koes BW, van Tulder M, Lin CW, Macedo LG, mcauley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-94. Doi: https://doi.org/10.1007/s00586-010-1502-y PMid:20602122 PMCid:PMC2997201
Stander J, Grimmer K, Brink Y. A user-friendly clinical practice guideline summary for managing low back pain in South Africa. The South African journal of physiotherapy. 2020;76(1):1-6. Doi: https://doi.org/10.4102/sajp.v76i1.1366 PMid:32161826 PMCid:PMC7059441
Zaina F, Côté P, Cancelliere C, Di Felice F, Donzelli S, Rauch A, et al. A systematic review of clinical practice guidelines for persons with non-specific low back pain with and without radiculopathy: Identification of best evidence for rehabilitation to develop the WHO's package of interventions for rehabilitation. Arch Phys Med Rehabil. 2023;104(11):1913-27. Doi: https://doi.org/10.1016/j.apmr.2023.02.022 PMid:36963709
O'Sullivan PB, Caneiro JP, O'Keeffe M, Smith A, Dankaerts W, Fersum K, et al. Cognitive Functional Therapy: An integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther. 2018;98(5):408-23. Doi: https://doi.org/10.1093/ptj/pzy022 PMid:29669082 PMCid:PMC6037069
Guo X, Li L, Yan Z, Li Y, Peng Z, Yang Y, et al. Efficacy and safety of treating chronic nonspecific low back pain with radial extracorporeal shock wave therapy (reswt), reswt combined with celecoxib and eperisone (C + E) or C + E alone: a prospective, randomized trial. J Orthop Surg Res. 2021;16(1):1-23. Doi: https://doi.org/10.1186/s13018-021-02848-x PMid:34863239 PMCid:PMC8642949
Wolfe D, Rosenstein B, Fortin M. The effect of transcutaneous electrotherapy on lumbar range of motion and paraspinal muscle characteristics in chronic low back pain patients: A systematic review and meta-analysis. J Clin Med. 2023;12(14):1-16. Doi: https://doi.org/10.3390/jcm12144680 PMid:37510796 PMCid:PMC10380811
Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Brønfort G, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013;2013(8):1-3. Doi: https://doi.org/10.1002/14651858.CD003010.pub5 PMid:23959683 PMCid:PMC6823219
Centre for reviews and dissemination:Systematic Reviews. CRD's Guidance for Undertaking Reviews in Health Care.,York: University of York; 2006. https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7):e1000097. Doi: https://doi.org/10.1371/journal.pmed.1000097 PMid:19621072 PMCid:PMC2707599
Grimmer K, Dizon JM, Milanese S, King E, Beaton K, Thorpe O, et al. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Medical Research Methodology. 2014;14(1):1-12. Doi: https://doi.org/10.1186/1471-2288-14-63 PMid:24885893 PMCid:PMC4033487
Staali JB, hendriksii EJM, heijmansiii M, H. Kiersiv AM, Lutgers-Boomsma, Rutten G, et al. KNGF Guideline Low back pain. The Netherlands: Royal Dutch Society for Physical Therapy; 2013. https://www.kngf.nl/binaries/content/assets/kennisplatform/onbeveiligd/guidelines/low-back-pain-2021/kngf_guide_on_low_back_pain_practice_guideline.pdf.
Scottish Intercollegiate Guidelines Network. Management of chronic pain. Edinburgh; 2013 December 2013. Contract No.: SIGN publication no. 136. http://www.sign.ac.uk.
National Guideline Centre. National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE), 2016. https://pubmed.ncbi.nlm.nih.gov/27929617/.
Wambeke PV, Anja D, Luc A, Berquin A, Demoulin C, Depreitere B, et al. Low back pain and radicular pain: assessment and management. KCE Report; 2017. No.: D/2017/10.273/36.https://kce.fgov.be/sites/default/files/2021-11/KCE_287_Low_back_pain_Report.pdf.
Institute of Health Economics. Toward Optimized Practice (TOP) Low Back Pain Working Group.Evidence-informed primary care management of low back pain: Clinical practice guideline. Edmonton, AB: Toward Optimized Practice. Alberta; 2017. http://www.topalbertadoctors.org/cpgs/885801.
Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG. Non-Specific low back pain. Dtsch Arztebl Int. 2017;114(51-52):883-90. Doi: https://doi.org/10.3238/arztebl.2017.0883 PMid:29321099 PMCid:PMC5769319
Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75. Doi: https://doi.org/10.1007/s00586-017-5099-2 PMid:28429142
Philippine Academy of Rehabilitation Medicine. Clinical Practice Guidelines on the Diagnosis and Management of Low Back Pain. Philippine Academy of RehabilitationMedicine; 2017. https://docplayer.net/storage/101/152166143/1693752648/vnmjslXloHnxTq5fswy3fg/152166143.pdf.
Institute for Clinical Systems Improvement. Health Care Guideline:Adult Acute and Subacute Low Back Pain. United States of America; 2018. www.icsi.org.
North American Spine Society. Evidence-Based Clinical Guideline for Multidisciplinary Spinal Care: Diagnosis & Treatment of Low Back Pain. Illinois; 2020.https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/Guidelines/LowBackPain.pdf.
George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021;51(11):Cpg1-cpg60. Doi: https://doi.org/10.2519/jospt.2021.0304 PMid:34719942 PMCid:PMC10508241
World Health Organisation. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva; 2023. https://iris.who.int/bitstream/handle/10665/374726/9789240081789-eng.pdf
Kaiser Foundation. Non-specific Back Pain Guideline. Washington; 2021. https://healthy.kaiserpermanente.org/
Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney; 2022. https://www.safetyandquality.gov.au/sites/default/files/2022-08/low_back_pain_clinical_care_standard.pdf.
Leach MJ, Climstein M, Fryer G, Kumar S, Agnew T. Mapping guideline-informed care for chronic non-specific low back pain with the biopsychosocial approach: A rapid review. Pain Pract. 2023;23(5):543-52. Doi: https://doi.org/10.1111/papr.13214 PMid:36853009
Hochheim M, Ramm P, Amelung V. The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A systematic review with meta-analysis. Pain Practice. 2023;23(4):409-36. Doi: https://doi.org/10.1111/papr.13198 PMid:36565010
Hall A, Richmond H, Copsey B, Hansen Z, Williamson E, Jones G, et al. Physiotherapist-delivered cognitive-behavioural interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review. Disability and Rehabilitation. 2018;40(1):1-9. Doi: https://doi.org/10.1111/papr.13198 PMid:36565010
Schega L, Kaps B, Broscheid K-C, Bielitzki R, Behrens M, Meiler K, et al. Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (multimove): study protocol for a randomized controlled trial. BMC Geriatrics. 2021;21(1):151. Doi: https://doi.org/10.1186/s12877-021-02093-1 PMid:33653286 PMCid:PMC7923646
Satria Nugraha MH. Multimodal treatment program in non-specific low back pain - A case series. Jurnal Penelitian Pembelajaran. 2022;8:217-25. Doi: https://doi.org/10.29407/js_unpgri.v8i2.18397
Shipton EA. Physical therapy approaches in the treatment of low back pain. Pain Ther. 2018;7(2):127-37. Doi: https://doi.org/10.1007/s40122-018-0105-x PMid:30229473 PMCid:PMC6251828
Jette NG, Lim YL, Lim HL, Mokhtar SA, Gan KB, Singh DK. Lumbar Kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain. Sultan Qaboos Univ Med J. 2016;16(4):e430-e6. Doi: https://doi.org/10.18295/squmj.2016.16.04.005 PMid:28003888 PMCid:PMC5135453
Zahid R, Khan I, Anis R, Ahmad H, Riaz S. Role of electrotherapy in treating chronic musculoskeletal conditions: A narrative review of the last 5 years. International Health Review. 2022;2:47-60. Doi: https://doi.org/10.32350/ihr.22.05
Slater D, Korakakis V, O'Sullivan P, Nolan D, O'Sullivan K. "Sit Up Straight": Time to re-evaluate. J Orthop Sports Phys Ther. 2019;49(8):562-4. Doi: https://doi.org/10.2519/jospt.2019.0610 PMid:31366294
Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. Doi: https://doi.org/10.1136/bjsports-2018-099878 PMid:30826805
Kaur D, Singh DKA, Ying J, Lin Y, Subramaniam P, Mesbah N, et al. Perspective regarding pain and fear-avoidance belief in adults with chronic non-specific low back pain. 2018;2:48-56. https://www.researchgate.net/publication/334458352_PERSPECTIVE_REGARDING_PAIN_AND_FEAR-AVOIDANCE_BELIEF_IN_ADULTS_WITH_CHRONIC_NON-SPECIFIC_LOW_BACK_PAIN.
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