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Chiropractic Research Review

International LBP Guidelines Vary

Treatment for low back pain (LBP) differs significantly between different types of specialists and between different countries. To make treatment methods consistent with current research, clinical guidelines have been established in some nations.

Each countrys guidelines are expected to be similar to one another, according to the authors of this study, because they are based on the same scientific evidence.

The authors compared the most recently published clinical guidelines on LBP for primary care providers from 11 countries. Only one set of guidelines per country was chosen, including the Agency for Health Care Policy and Research (AHCPR) guidelines in the U.S. All guidelines were published between 1994 and 2000, and were printed in English, Dutch, or German.

Results: The diagnostic information in the guidelines was similar, according to the authors, including suggestions for gradual activation of patients, discouraging bed rest as treatment, and acknowledging psychosocial risk factors for LBP. The guidelines varied, however, on recommendations for exercise therapy, spinal manipulation, and use of muscle relaxants. Guidelines from the U.S., the United Kingdom, Australia, and New Zealand focused only on acute LBP, while those from other countries considered acute and chronic LBP. Dutch, Australian, and Israeli guidelines did not advocate spinal manipulation; the guidelines for other countries offered vague definitions for manipulation and suggested it at differing times during treatment.

The authors point out that this study focuses on the status quo of clinical guidelines only, and is not a critical assessment of the guidelines validity.

Koes BW, van Tulder MW, Ostelo R, et al. Clinical guidelines for the management of low back pain in primary care. Spine 2001:26(22), pp. 2504-2514.

Chiropractic Research Review

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