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Quality of Low Back Pain Guidelines Improved
Spine, 10/30/09

Bouwmeester WPT et al. – Compared to the quality assessment performed in 2004, the average quality of guidelines has improved. However, guideline developers should still improve the quality transparency of the development process. Especially the applicability of guidelines and the editorial independence need to be ensured in future guidelines.

Methods

Guidelines published since 2004 were selected by electronically searching in MEDLINE, Cochrane Back Review Group database, Guideline Clearing House, Google, and contacting experts.
The methodological quality of the guidelines was assessed by 2 authors independently, using the Appraisal of Guidelines, Research, and Evaluation in Europe instrument.
Also, the diagnostic and therapeutic recommendations were compared.

Results

14 guidelines were included.
In general, the quality was satisfactory.
The guidelines had best scores on clarity and presentation.
The domain scores of scope and purpose were often moderate due to the absence of description of the clinical questions.
The domain of stakeholder involvement scored moderate, mostly because guidelines were not tested among target users.
Domains that had generally low scores were applicability and editorial independence.
Four guidelines scored low on the rigor of development, but the other guidelines scored high on this domain.
The diagnostic and therapeutic recommendations in the guidelines for acute LBP were mainly comparable while the recommendations for the management of chronic LBP varied widely.