Clinical Guidelines for the Management of Low Back Pain in Primary Care: An International Comparison


Clinical Guidelines for the Management of Low Back Pain in Primary Care: An International Comparison

Bart W. Koes, PhD; Maurits W. van Tulder, PhD; Raymond Ostelo, MSc;
A. Kim Burton, PhD, DO; Gordon Waddell, DSc, MD, FRCS

Department of General Practice,
Erasmus University, Rotterdam

Study Design:   Descriptive study.

Objectives:   To compare national clinical guidelines on low back pain.

Summary of Background Data:   To rationalize the management of low back pain, clinical guidelines have been issued in various countries around the world. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment.

Methods:   Guidelines were included that met the following criteria: the target group consisted of primary care health professionals, and the guideline was published in English, German, or Dutch. Only one guideline per country was included: the one most recently published.

Results:   Clinical guidelines from 11 different countries published from 1994 until 2000 were included in this review. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features were the early and gradual activation of patients, the discouragement of prescribed bed rest, and the recognition of psychosocial factors as risk factors for chronicity. However, there were discrepancies for recommendations regarding exercise therapy, spinal manipulation, muscle relaxants, and patient information.

Conclusion:   The comparison of clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations were generally similar. Updates of the guidelines are planned in most countries, although so far produced only in the United Kingdom. However, new evidence may lead to stronger conclusions and enable future guidelines to become even more concordant.

Key words:   clinical guidelines; low back pain; evidence based medicine; systematic reviews