Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain
D Scott Kreiner 1, Paul Matz 2, Christopher M Bono 3, Charles H Cho 4, John E Easa 5, Gary Ghiselli 6, Zoher Ghogawala 7, Charles A Reitman 8, Daniel K Resnick 9, William C Watters 3rd 10, Thiru M Annaswamy 11, Jamie Baisden 12, Walter S Bartynski 13, Shay Bess 14, Randall P Brewer 15, R Carter Cassidy 16, David S Cheng 17, Sean D Christie 18, Norman B Chutkan 19, Bernard Allan Cohen 20, Simon Dagenais 21, Dennis E Enix 22, Paul Dougherty 23, S Raymond Golish 24, Padma Gulur 13, Steven W Hwang 25, Cumhur Kilincer 26, Jeffrey A King 12, Adam C Lipson 27, Anthony J Lisi 28, Richard J Meagher 29, John E O’Toole 30, Paul Park 31, Murat Pekmezci 32, Daniel R Perry 33, Ravi Prasad 34, David A Provenzano 35, Kris E Radcliff 36, Gazanfar Rahmathulla 37, Tom E Reinsel 38, Robert L Rich Jr 39, Daniel S Robbins 40, Karie A Rosolowski 41, Jonathan N Sembrano 42, Anil K Sharma 43, Alison A Stout 44, Christopher K Taleghani 45, Ryan A Tauzell 46, Terry Trammell 47, Yakov Vorobeychik 48, Amy M Yahiro 41
- PMID: 32333996
- DOI: 10.1016/j.spinee.2020.04.006
Abstract
Background context: The North American Spine Society’s (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016.
Purpose: The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.
Study design: This is a guideline summary review.
Methods: This guideline is the product of the Low Back Pain Work Group of NASS’ Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.
Results: Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.
Conclusions: The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
Keywords: Cost utility; Diagnosis; Evidence-based guideline; Low back pain; Lumbago; Lumbar; Lumbar pain; Lumbosacral; Prognosis; Treatment.
