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Joint Bone Spine
Volume 79, n° 2
pages 176-185 (mars 2012)
Doi : 10.1016/j.jbspin.2011.03.019
accepted : 23 Mars 2011
An updated overview of clinical guidelines for chronic low back pain management in primary care

Paolo Pillastrini a, 1, , Ivan Gardenghi a, Francesca Bonetti a, Francesco Capra a, Andrew Guccione b, Raffaele Mugnai a, Francesco S. Violante a
a 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 
b Department of Rehabilitation Science, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA, 22030 USA 

Corresponding author. Tel.: +39 051 63 62 496; fax: +39 051 63 62 609.

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.


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.


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.


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.

The full text of this article is available in PDF format.

Keywords : Chronic low back pain, Clinical guidelines, Quality assessment, Diagnosis, Treatment

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