Quality of primary care guidelines for acute low back pain.
METHODS
Systematic review of clinical guidelines.


OBJECTIVE
To assess the methodologic quality of existing guidelines for the management of acute low back pain.


BACKGROUND
Guidelines are playing an increasingly important role in evidence-based practice. After publication of the Quebec Task Force in Canada in 1987 and the Agency for Health Care Policy and Research guidelines in the United States in 1994, guidelines for acute low back pain were developed in many other countries. However, little is known about the methodologic quality of these guidelines.


METHODS
Guidelines were selected by electronically searching MEDLINE and the Internet and through personal communication with experts in the field of low back pain research in primary care. The methodologic quality of the guidelines was assessed by two authors independently using the AGREE instrument.


RESULTS
A total of 17 guidelines were included. Overall, the quality of reporting of guidelines was disappointing. Most guidelines clearly described the aim of the guideline and its target population, and most guideline development committees were multiprofessional. However, many other methodologic flaws were identified. More than half of the guidelines did not take patients' preferences into account, did not perform a pilot test among target users, did not clearly describe the methods of study identification and selection, did not include an external review, did not provide a procedure for updating, were not supported with tools for application, did not consider potential organizational barriers and cost implications, did not provide criteria for monitoring and audit, did not include recommendations for implementation strategies, and did not adequately record editorial independence and conflict of interest of the members. The diagnostic and therapeutic recommendations of the guidelines were largely similar.


CONCLUSIONS
The quality and transparency of the development process and the consistency in the reporting of primary care guidelines for low back pain need to be improved.
van Tulder
Maurits W
MW
Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands. mw.van_tulder.emgo@med.vu.nl
Tuut
Mariska
M
Pennick
Victoria
V
Bombardier
Claire
C
Assendelft
Willem J J
WJ
D000208:Acute Disease; D001315:Australia; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D007557:Israel; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D009520:New Zealand; D009656:North America; D017060:Patient Satisfaction; D010865:Pilot Projects; D011050:Policy Making; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D012107:Research Design; D014956:Writing