Resumen

ACEVEDO, J. C.; SARDI, J. P.  y  GEMPELER, A.. Systematic review and appraisal of clinical practice guidelines on interventional management for low back pain. Rev. Soc. Esp. Dolor [online]. 2016, vol.23, n.5, pp.243-255. ISSN 1134-8046.

Objective: This article presents a systematic review of the literature on evidence based clinical practice guidelines for the interventional management of chronic low back pain and appraisal of the methodological quality of the guidelines and their recommendations. Methods: A systematic literature review was conducted using electronic databases of The National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane Back Review Group, PubMed, Clinical Evidence and Google. Only clinical practice guidelines on chronic low back pain treatment that encompassed interventional management were included. Two individual appraisers used the AGREE-II instrument to assess the methodological quality of the guidelines and also compare the recommendations regarding the invasive management of chronic low back pain. Results: Five guidelines published since 2005 met the inclusion criteria but only one was specific to interventional treatments. According to the AGREE-II, domains 1 (scope and purpose) and 6 (editorial independence) obtained the highest scores, while domains two (Stakeholder involvement) and five (Applicability) ranked lowest. Recommendations regarding diagnosis and non-invasive treatments were similar throughout the guidelines, however the evidence for interventional management was variable and inconsistent. Conclusions: In general guidelines exhibited a satisfactory methodological development and the most recent publications presented a better quality. However there was a consistent lack of clarity regarding cost-effectiveness, external peer review and implementation that we consider limit the adherence and distribution of the guidelines. Additionally, recommendations should be examined in the context of each patient, as per most targeted non-specific low back pain, which alters the level of evidence for the interventions reviewed.

Palabras clave : Low back pain; guidelines; practice guidelines; quality assurance; systematic review.

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