背景:下腰痛(LBP)是全球范围内的重大健康问题,在一般成年人群中终生患病率为84%。为了使LBP的管理合理化,临床实践指南(CPG)已在世界各国发布。本研究旨在确定和比较最近的CPG对世界各地LBP管理的建议。
方法:MEDLINE,EMBASE,CINAHL,PEDro,并在2017年至2022年期间搜索了主要指南数据库以识别CPG。关注非特异性LBP管理和/或治疗信息的CPG被认为是合格的。使用《研究与评价指南评价》(AGREE)II工具对纳入指南的质量进行了评价。
结果:我们的分析确定了总共22个符合纳入标准的CPG,根据AGREEII工具的评估,具有中等和较高的方法学质量。指南在他们的建议中表现出异质性,特别是在LBP不同阶段的方法中。对于急性LBP,指南建议使用非甾体抗炎药(NSAIDs),治疗性锻炼,保持活跃,和脊柱操纵。对于亚急性LBP,指南建议使用NSAIDs,治疗性锻炼,保持活跃,和脊柱操纵。对于慢性LBP,指南推荐的治疗性锻炼,使用NSAIDs,脊柱操纵,和针灸。
结论:当前的CPG为LBP管理的几乎所有主要方面提供了建议,但是它们之间存在明显的异质性。一些建议缺乏明确性,并且与指南中的其他治疗方法重叠。
BACKGROUND: Low back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice
guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world.
METHODS: MEDLINE, EMBASE, CINAHL, PEDro, and major
guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included
guidelines was evaluated using the Appraisal of
Guidelines for Research and Evaluation (AGREE) II instrument.
RESULTS: Our analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the
guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture.
CONCLUSIONS: Current CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the
guidelines.