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Preface to Revised EditionThere is now a considerable weight of evidence, linked with international experience, to show that clinical guidelines are only likely to influence practice if these guidelines form part of an implementation programme. In the Royal College of General Practitioners there is a recognition that local activity on guideline development is a key mechanism for gaining the ownership necessary to make changes in clinical practice. The purpose of national guidelines is therefore two-fold. First, to use national resources to bring the evidence together and to draw on a wide network to construct appropriate recommendations. As such, national guidelines are an efficient means of providing evaluated evidence for the professions. Second, to provide easily accessible evidence-based recommendations which may be all that is required for a local implementation programme to get under way. The brief guidelines, made extensively available to the professions involved with back pain care, are overleaf. Alternatively, the more extensive evaluation of the evidence and the supplementary recommendations to be found in the Review can provide the basis for local guidelines. This should lessen the effort required to develop local versions. This evidence review was constructed to support the development of national clinical guidelines for the management of acute low back pain. It has been written on behalf of a multi-professional team led by the Royal College of General Practitioners and subjected to extensive external scientific review. International research evidence has been accessed to undertake this review. The methods used are described in Chapter 1 and the principal evidence statements are set out in Chapter 2, together with a weighting of the evidence. Recommendations for clinical practice, linked to the evidence in support of each recommendation, form the basis of Chapter 3. Each recommendation has been the subject of extensive debate within the development group. Additional material from the back pain report of the UK Clinical Standards Advisory Group comprises Chapter 4. There is an international interest in the primary care management of acute back pain, including the work of the Cochrane Collaboration and new evidence is constantly adding to knowledge on back pain management. The RCGP Effective Clinical Practice Programme therefore agreed to review the 1996 edition of the guidelines to determine whether changes should be made to the principal recommendations. This review was undertaken in late 1998 and the development team has recommended consideration for further review in December 2001. It would not have been possible to undertake this project without the very considerable contributions of the development group, reviewers and agencies who provided support, particularly the National Health Service Executive and collaborating colleges and associations. An evidence review by Gordon Waddell and Maurits van Tulder was especially helpful. My thanks are due to all of them, on behalf of the College.
Allen Hutchinson
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