Inconsistent Grading of Evidence Across Countries: A Review of Low Back Pain Guidelines

Audrey Y.M.T. Murphy, Edwin R. van Teijlingen and Mary O. Gobbi

The aim of this study was to report clinical treatment recommendations for low back pain (LBP) based on 5 international guidelines and best evidence from the Cochrane database of systematic reviews.  Five LBP guidelines available in English language were appraised, including 4 studies published since the seminal work by Koes et al (Spine 2001;26:2504-5213). According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP.The authors concluded that treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive.

Journal of Manipulative and Physiological Therapeutics, Volume 29, Issue 7, September 2006, Page 576

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