title: How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.
abstract: OBJECTIVE
  The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs.
  
  
  METHODS
  We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs.
  
  
  RESULTS
  Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence.
  
  
  CONCLUSIONS
  The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.
authors: Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea.
authors: Hyun-Woo
authors: HW
authors: Cho
authors: Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea ; Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.
authors: Eui-Hyoung
authors: EH
authors: Hwang
authors: Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.
authors: Byungmook
authors: B
authors: Lim
authors: Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea.
authors: Kwang-Ho
authors: KH
authors: Heo
authors: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
authors: Jian-Ping
authors: JP
authors: Liu
authors: Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
authors: Kiichiro
authors: K
authors: Tsutani
authors: Brain Disease Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
authors: Myeong Soo
authors: MS
authors: Lee
authors: Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea ; Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.
authors: Byung-Cheul
authors: BC
authors: Shin
mesh_terms: D005202:Asia, Eastern; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008518:Medicine, East Asian Traditional / Q000379:methods / Q000592:standards; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic