title: An updated overview of clinical guidelines for chronic low back pain management in primary care.
abstract: OBJECTIVE
  In the past decade many countries around the world have produced clinical practice guidelines to assist practitioners in providing a care that is aligned with the best evidence. The aim of this study was to present and compare the most established evidence-based recommendations for the management of chronic nonspecific low back pain in primary care derived from current high-quality international guidelines.
  
  
  METHODS
  Guidelines published or updated since 2002 were selected by searching PubMed, CINAHL, EMBASE, guidelines databases, and the World Wide Web. The methodological quality of the guidelines was assessed by three authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Guideline recommendations were synthesized into diagnostic and therapeutic approaches that were supported by strong, moderate or weak evidence.
  
  
  RESULTS
  Thirteen guidelines were included. In general, the quality was satisfactory. Guidelines had highest scores on clarity and presentation and scope and purpose domains, and lowest scores on applicability. There was a strong consensus among all the guidelines particularly regarding the use of diagnostic triage and the assessment of prognostic factors. Consistent therapeutic recommendations were information, exercise therapy, multidisciplinary treatment, and combined physical and psychological interventions.
  
  
  CONCLUSIONS
  Compared to previous assessments, the average quality of the guidelines dealing with chronic low back pain has improved. Furthermore, all guidelines are increasingly aligning in providing therapeutic recommendations that are clearly differentiated from those formulated for acute pain. However, there is still a need for improving quality and generating new evidence for this particular condition.
authors.affiliation: Occupational Medicine Unit, Department of Internal Medicine, Geriatrics and Nephrology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, via P. Palagi 9, 40138 Bologna, Italy. paolo.pillastrini@unibo.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Pillastrini
authors.forename: Ivan
authors.initials: I
authors.lastname: Gardenghi
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Capra
authors.forename: Andrew
authors.initials: A
authors.lastname: Guccione
authors.forename: Raffaele
authors.initials: R
authors.lastname: Mugnai
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Violante
mesh_terms: D002908:Chronic Disease; D019468:Disease Management; D055317:Evidence-Based Practice; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results