A Systematic Review of Clinical Practice Guidelines for Persons
With Non-specific Low Back Pain With and Without Radiculopathy:
Identification of Best Evidence for Rehabilitation to Develop
the WHO's Package of Interventions for Rehabilitation

This section is compiled by Frank M. Painter, D.C.
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FROM:   Arch Phys Med Rehabil 2023 (Mar 23) [EPUB] ~ FULL TEXT


Fabio Zaina, MD, Pierre Côté, PhD, Carolina Cancelliere, PhD, Leslie Verville, MHSc, Stefano Negrini, MD, PhD, Margareta Nordin, Dr Med Sci

ISICO (Italian Scientific Spine Institute),
Milan, Italy.

Faculty of Health Sciences,
Ontario Tech University,
Oshawa, Ontario, Canada;

FROM:   Lancet 2021

Objective:   To Identify evidence-based rehabilitation interventions for persons with non-specific low back pain (LBP) with and without radiculopathy and to develop recommendations from high-quality clinical practice guidelines (CPGs) to inform the World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR).

Data source:   We searched MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Services Economic Evaluation Database, Health Technology Assessment Database, PEDro, the Trip Database, the Index to Chiropractic Literature and the gray literature.

Study selection:   Eligible guidelines were (1) published between 2009 and 2019 in English, French, Italian, or Swedish; (2) included adults or children with non-specific LBP with or without radiculopathy; and (3) assessed the benefits of rehabilitation interventions on functioning. Pairs of independent reviewers assessed the quality of the CPGs using AGREE II.

Data synthesis:   We identified 4 high-quality CPGs. Recommended interventions included

(1)   education about recovery expectations, self-management strategies, and maintenance of usual activities;

(2)   multimodal approaches incorporating education, exercise, and spinal manipulation;

(3)   nonsteroidal anti-inflammatory drugs combined with education in the acute stage; and

(4)   intensive interdisciplinary rehabilitation that includes exercise and cognitive/behavioral interventions for persistent pain.

We did not identify high-quality CPGs for people younger than 16 years of age.

Conclusion:   We developed evidence-based recommendations from high-quality CPGs to inform the WHO PIR for people with LBP with and without radiculopathy. These recommendations emphasize the potential benefits of education, exercise, manual therapy, and cognitive/behavioral interventions.

Keywords:   Education; Quality of life; Rehabilitation; Sciatica.

From the FULL TEXT Article:

Supplementary Material


List of abbreviations:

CPG = (clinical practice guideline),
LBP = (low back pain),
NICE = (National Institute for Health and Clinical Excellence),
NSAID = (nonsteroidal anti-inflammatory drug),
PIR = (Package of Interventions for Rehabilitation),
WHO = (World Health Organization)

Disclosure statement

S.N. owns stock of ISICO and is the inventor of the patent no. 102019000003045, 4-2-2021 and patent no. 102020000003991, 24/3/2022. P.C. holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University, funded by the Canadian Chiropractic Research Foundation (CCRF). L.V. is supported by the CCRF. C.C. holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University, funded by the Canadian Chiropractic Research Foundation (CCRF). The other authors have no conflict of interest.

This work was supported and funded, in part, by the Italian Ministry of Health—Ricerca Corrente [2022] to Professor Stefano Negrini, Full Professor in Physical and Rehabilitation Medicine (PRM) at University “La Statale”, Milan. Alexandra Rauch works for the World Health Organization (WHO) in Head Quarters, Geneva. She alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of WHO.


This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program to Professor Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University.


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