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Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
The CPGs for LBP were updated in 2021. They include research published through July 1, 2020. CPG EVIDENCE LEVELS Research studies are assigned a rating from I to V: I = High-quality research study: Diagnostic Lesser-quality research study: Diagnostic studies, prospective studies, randomized controlled trials, or systematic reviews III = Case-control studies or retrospective studies IV = Case series V = expert opinion studies, prospective studies, randomized controlled trials, or systematic reviews II = 2021 CPG Updates Additional interventions now included that were not considered in 2012: • Dry needling • Cognitive functional therapy • Pain neuroscience education • CPG intervention categories ○ Exercise ○ Manual therapy and other directed therapies ○ Classification systems ○ Client education The committee made the decision to include only the highest quality research in the 2021 update. The strength for all recommendations is level I or II.
INTRODUCTION Low back pain (LBP) is the fifth most common reason for visiting a doctor in the U.S. There are typically three distinct sources of pain: • Axial lumbosacral (localized) • Radicular (dermatomal pattern) • Referred pain (nondermatomal trajectory) Chronicity is broken down into: • Acute: <6 weeks • Subacute: 6–12 weeks • Chronic: >12 weeks FINANCIAL COST OF LOW BACK PAIN LBP is the leading cause of disability and work absenteeism globally. There is a $50 billion to $100 billion annual cost due to direct medical and indirect costs. Approximately $1.7 billion in indirect costs includes things such as work absenteeism. This costs approximately $1,226.25 per individual. The rate of hospitalization from LBP is approximattely 13.4% and 18.7%. CLINICAL PRACTICE GUIDELINES (CPGS) The intent of CPGs is to improve quality of care. CPGs are used in multiple healthcare disciplines and are based on a plethora of recent high-quality research . CPGs must be periodically updated. They are not a protocol or regulation and not a substitute for expert medical advice. LEARNING TIP! Benefits of using CPGs pertaining to LBP: • Reduced length of painful episode • Reduced healthcare costs • Decreased unnecessary imaging • Decreased opioid use • Decreased surgery • Improved patient/client occupational and functional performance
INTERPRETING STRENGTH OF RECOMMENDATIONS Letter Grade Grade of Recommendation Strength of Evidence
Level of Obligation
A Strong evidence
Multiple level I-II studies support the recommendation. Must include at least level I study A single level I study or several level II studies support the recommendation
"Should"
B
Moderate evidence
"May"
C Weak evidence
A single level II study supports the recommendation "Can"
D Conflicting or no evidence
High level studies disagree with respect to their conclusions to provide no evidence of benefit
"Should Not"
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