Article

In the past decade many countries around the world have produced
clinical practice guidelines to assist practitioners in providing a care that is
aligned with the best evidence. The aim of this study was to present and compare
the most established evidence-based recommendations for the management of chronic
nonspecific low back pain in primary care derived from current high-quality
international guidelines. METHODS: Guidelines published or updated since 2002
were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the
World Wide Web. The methodological quality of the guidelines was assessed by
three authors independently, using the Appraisal of Guidelines for Research and
Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into
diagnostic and therapeutic approaches that were supported by strong, moderate or
weak evidence. RESULTS: Thirteen guidelines were included. In general, the
quality was satisfactory. Guidelines had highest scores on clarity and
presentation and scope and purpose domains, and lowest scores on applicability.
There was a strong consensus among all the guidelines particularly regarding the
use of diagnostic triage and the assessment of prognostic factors. Consistent
therapeutic recommendations were information, exercise therapy, multidisciplinary
treatment, and combined physical and psychological interventions. CONCLUSION:
Compared to previous assessments, the average quality of the guidelines dealing
with chronic low back pain has improved. Furthermore, all guidelines are
increasingly aligning in providing therapeutic recommendations that are clearly
differentiated from those formulated for acute pain. However, there is still a
need for improving quality and generating new evidence for this particular
condition.
=article paru en français dans la Revue du Rhumatisme 2011 58/6 p557­567 Recommandations cliniques pour la prise en charge des lombalgies chroniques communes en médecine de premier recours : rhumatime

Langue : ANGLAIS ; FRANCAIS