Quality of Complementary and Alternative Medicine Recommendations in Low Back Pain Guidelines: a Systematic Review

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2020 Apr 3

PMID 32236685

Citations 11

Authors

Jeremy Y Ng

Uzair Mohiuddin

Affiliations

Soon will be listed here.

Abstract

Background: Individuals with low back pain (LBP) often turn to complementary and alternative medicine (CAM) to seek relief. The purpose of this study was to determine mention of CAM in LBP clinical practice guidelines and assess the quality of CAM recommendations using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.

Methods: A systematic review was conducted to identify LBP guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines providing CAM recommendations were assessed with the AGREE II instrument.

Results: From 181 unique search results, 22 guidelines on the treatment and/or management of LBP were found, and 17 made recommendations on CAM therapy. With regard to scaled domain percentages, this overall guideline scored higher than the CAM section for 4 of 6 domains (overall, CAM): (1) scope and purpose (88.6%, 87.1%), (2) clarity of presentation (83.0%, 73.2%), (3) stakeholder involvement (57.0%, 41.7%), (4) rigor of development (47.2%, 44.7%), (5) editorial independence (34.8%, 34.8%) and (6) applicability (31.8%, 21.8%).

Conclusions: The majority of LBP guidelines made CAM recommendations. The quality of CAM recommendations is significantly lower than overall recommendations across all domains with the exception of scope and purpose and editorial independence. This difference highlights the need for CAM recommendation quality improvement. Future research should identify CAM therapies which are supported by sufficient evidence to serve as the basis for guideline development. These slides can be retrieved under Electronic Supplementary Material.

Citing Articles

Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines.

Zhao F, Xu P, Kennedy G, Conduit R, Zhang W, Wang Y Front Public Health. 2023; 11:1157419.

PMID: 37397764 PMC: 10308125. DOI: 10.3389/fpubh.2023.1157419.

Neck pain clinical practice guidelines: a systematic review of the quality and quantity of complementary and alternative medicine recommendations.

Ng J, Uppal M, Steen J Eur Spine J. 2022; 31(10):2650-2663.

PMID: 35869329 DOI: 10.1007/s00586-022-07288-7.

More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted?.

Gianola S, Bargeri S, Cinquini M, Iannicelli V, Meroni R, Castellini G BMC Med Res Methodol. 2022; 22(1):184.

PMID: 35790902 PMC: 9254584. DOI: 10.1186/s12874-022-01621-w.

Quality assessment of Japanese clinical practice guidelines including recommendations for acupuncture.

Okawa Y, Yamashita H, Masuyama S, Fukazawa Y, Wakayama I Integr Med Res. 2022; 11(3):100838.

PMID: 35340335 PMC: 8943251. DOI: 10.1016/j.imr.2022.100838.

What traditional, complementary, and integrative medicine recommendations exist across osteoporosis clinical practice guidelines? A systematic review and quality assessment.

Ng J, Hilal A, Maini I Integr Med Res. 2021; 11(2):100803.

PMID: 34840950 PMC: 8605333. DOI: 10.1016/j.imr.2021.100803.

References

Qaseem A, Wilt T, McLean R, Forciea M, Denberg T, Barry M . Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017; 166(7):514-530. DOI: 10.7326/M16-2367. View

Brosseau L, Wells G, Poitras S, Tugwell P, Casimiro L, Novikov M . Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. J Bodyw Mov Ther. 2012; 16(4):424-55. DOI: 10.1016/j.jbmt.2012.04.002. View

Chou R, Loeser J, Owens D, Rosenquist R, Atlas S, Baisden J . Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009; 34(10):1066-77. DOI: 10.1097/BRS.0b013e3181a1390d. View

Kent P, Keating J . The epidemiology of low back pain in primary care. Chiropr Osteopat. 2005; 13:13. PMC: 1208926. DOI: 10.1186/1746-1340-13-13. View

Wolsko P, Eisenberg D, Davis R, Kessler R, Phillips R . Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine (Phila Pa 1976). 2003; 28(3):292-7; discussion 298. DOI: 10.1097/01.BRS.0000042225.88095.7C. View

Foltz V, St Pierre Y, Rozenberg S, Rossignol M, Bourgeois P, Joseph L . Use of complementary and alternative therapies by patients with self-reported chronic back pain: a nationwide survey in Canada. Joint Bone Spine. 2005; 72(6):571-7. DOI: 10.1016/j.jbspin.2005.03.018. View

Chenot J, Becker A, Leonhardt C, Keller S, Donner-Banzhoff N, Baum E . Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study. BMC Complement Altern Med. 2007; 7:42. PMC: 2222227. DOI: 10.1186/1472-6882-7-42. View

Woolf S, Grol R, Hutchinson A, Eccles M, Grimshaw J . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999; 318(7182):527-30. PMC: 1114973. DOI: 10.1136/bmj.318.7182.527. View

Arnau J, Vallano A, Lopez A, Pellise F, Delgado M, Prat N . A critical review of guidelines for low back pain treatment. Eur Spine J. 2005; 15(5):543-53. PMC: 3489347. DOI: 10.1007/s00586-005-1027-y. View

10.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

11.

Ng J, Boon H, Thompson A, Whitehead C . Making sense of "alternative", "complementary", "unconventional" and "integrative" medicine: exploring the terms and meanings through a textual analysis. BMC Complement Altern Med. 2016; 16:134. PMC: 4875612. DOI: 10.1186/s12906-016-1111-3. View

12.

Groff M, Dailey A, Ghogawala Z, Resnick D, Watters 3rd W, Mummaneni P . Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion. J Neurosurg Spine. 2014; 21(1):75-8. DOI: 10.3171/2014.4.SPINE14277. View

13.

Chenot J, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr S . Non-Specific Low Back Pain. Dtsch Arztebl Int. 2018; 114(51-52):883-890. PMC: 5769319. DOI: 10.3238/arztebl.2017.0883. View

14.

Itz C, Willems P, Zeilstra D, Huygen F . Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine. Pain Pract. 2015; 16(1):90-110. DOI: 10.1111/papr.12318. View

15.

Globe G, Farabaugh R, Hawk C, Morris C, Baker G, Whalen W . Clinical Practice Guideline: Chiropractic Care for Low Back Pain. J Manipulative Physiol Ther. 2016; 39(1):1-22. DOI: 10.1016/j.jmpt.2015.10.006. View

16.

Delitto A, George S, Van Dillen L, Whitman J, Sowa G, Shekelle P . Low back pain. J Orthop Sports Phys Ther. 2012; 42(4):A1-57. PMC: 4893951. DOI: 10.2519/jospt.2012.42.4.A1. View

17.

Deyo R . Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976). 1987; 12(3):264-8. DOI: 10.1097/00007632-198704000-00013. View

18.

Hurwitz E, Morgenstern H . The effects of comorbidity and other factors on medical versus chiropractic care for back problems. Spine (Phila Pa 1976). 1997; 22(19):2254-63; discussion 2263-4. DOI: 10.1097/00007632-199710010-00011. View

19.

Shekelle P, Markovich M, Louie R . Comparing the costs between provider types of episodes of back pain care. Spine (Phila Pa 1976). 1995; 20(2):221-6; discussion 227. DOI: 10.1097/00007632-199501150-00018. View

20.

Walker B, Muller R, Grant W . Low back pain in Australian adults. health provider utilization and care seeking. J Manipulative Physiol Ther. 2004; 27(5):327-35. DOI: 10.1016/j.jmpt.2004.04.006. View