Using consensus methods in developing clinical guidelines for exercise in managing persistent low back pain

The objective of this study was to generate expert consensus evidence for the purpose of developing more complete guidelines for people with persistent low back pain than is possible using current research evidence alone. A modified Nominal Group Technique (NGT) was followed by a systematic review indicating incomplete research evidence.  There were three stages to this study: a first-round questionnaire of clinical questions unanswered by the systematic review; an electronic conference for outstanding questions unanswered by the first questionnaire; and a second-round questionnaire for these outstanding questions. All three stages were carried out electronically. Of 17 clinical questions unanswered by the systematic review, consensus evidence was generated for 14 questions by the modified NGT and this led to 14 recommendations for practice. Consensus was not reached for the remaining three questions.

The modified NGT was a practical and cost-effective way of generating consensus evidence from a UK-wide group. The consensus evidence was the basis of appropriately graded recommendations for effective care of people with persistent low back pain. Consensus methods have been little used in physiotherapy to date but are likely to be valuable in developing clinically useful, evidence-based tools for future practice.

Anne Jackson, Dries M. Hettinga, Judy Mead and Chris Mercer. Using consensus methods in developing clinical guidelines for exercise in managing persistent low back pain. Physiotherapy, Volume 95, Issue 4, December 2009, Pages 302-311

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