Abstract：
Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis.
Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung-Knapp-Sidik-Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively.
Of 886 records, 6 studies were included (N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction (p = 0.021, Fisher\'s method, risk of bias: low). This did not persist with sensitivity analysis (p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low).
Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions.
CRD42020215137.
Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung-Knapp-Sidik-Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively.
Of 886 records, 6 studies were included (N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction (p = 0.021, Fisher\'s method, risk of bias: low). This did not persist with sensitivity analysis (p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low).
Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions.
CRD42020215137.
摘要：
通过系统评价和荟萃分析，检查干预措施的有效性，以采用遵循指南的手术转诊评估下腰痛。
五个数据库（2021年9月10日），谷歌学者，我们搜索了相关系统综述的参考文献列表,并对纳入研究实施了前后引文跟踪.纳入了成人腰背痛患者的随机对照/临床试验，以优化手术率或转诊或二次转诊。使用CochraneROB2工具评估偏差，并通过建议评估分级进行证据确定性评估，开发和评估（等级）。使用PauleMandel估计器加上Hartung-Knapp-Sidik-Jonkman方法的随机效应荟萃分析来计算优势比和95％置信区间，分别。
在886条记录中,包括6项研究（N=258,329）参与者；集群大小从4到54。五项研究被评为低偏倚风险，一项研究被评为有一些担忧。两项报告脊柱手术转诊或转诊率的研究只能通过p值的组合进行汇总，并提供减少的证据(p=0.021，Fisher方法，偏差风险：低）。通过敏感性分析(p=0.053),这并不持续。对于二次转诊，荟萃分析显示，无显著优势比为1.07(95%CI[0.55，2.06]，I2=73.0%，n=4项研究，建议评估的分级，开发和评估[等级]证据确定性：非常低)。
很少有RCT用于提高脊柱手术率或转诊率的干预措施。孤立的临床医生教育可能无效。未来的RCT应考虑组织和/或政策层面的干预措施。
CRD42020215137。
五个数据库（2021年9月10日），谷歌学者，我们搜索了相关系统综述的参考文献列表,并对纳入研究实施了前后引文跟踪.纳入了成人腰背痛患者的随机对照/临床试验，以优化手术率或转诊或二次转诊。使用CochraneROB2工具评估偏差，并通过建议评估分级进行证据确定性评估，开发和评估（等级）。使用PauleMandel估计器加上Hartung-Knapp-Sidik-Jonkman方法的随机效应荟萃分析来计算优势比和95％置信区间，分别。
在886条记录中,包括6项研究（N=258,329）参与者；集群大小从4到54。五项研究被评为低偏倚风险，一项研究被评为有一些担忧。两项报告脊柱手术转诊或转诊率的研究只能通过p值的组合进行汇总，并提供减少的证据(p=0.021，Fisher方法，偏差风险：低）。通过敏感性分析(p=0.053),这并不持续。对于二次转诊，荟萃分析显示，无显著优势比为1.07(95%CI[0.55，2.06]，I2=73.0%，n=4项研究，建议评估的分级，开发和评估[等级]证据确定性：非常低)。
很少有RCT用于提高脊柱手术率或转诊率的干预措施。孤立的临床医生教育可能无效。未来的RCT应考虑组织和/或政策层面的干预措施。
CRD42020215137。
