Disclosures: Timothy Olivier, MD: No financial relationships or conflicts of interest

Objective: To assess the quality of clinical practice guidelines (CPGs) on interventional treatment of low back pain (LBP) and associated conditions.

Design: Systematic (3rd order Umbrella) review of CPGs and appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool.Setting : CPGs were created in: United States, United Kingdom, Denmark, European Union, Canada, Belgium, South Korea, Netherlands, Saudi Arabia, Australia, Russia. CPGs were created by a variety of governmental and professional societal organizations.Participants : Organizations from the above-mentioned regions that published the 21 analyzed CPGs.

Interventions: 714 initial documents were screened to 79 full texts which were vetted to 21 final appraised CPGs. These CPGs were appraised using the AGREE II tool.

Main Outcome Measures: For each CPG, the AGREE II appraisal assessed 23 items across 6 domains on a 7-point Likert scale. This yielded both an overall quality score and percent scores for each domain. Each CPG was also given an overall recommendation: “yes”, “yes with modifications”, or “no”. We also calculated the inter-rater reliability of our raters.

Results: 21 CPGs were appraised. In terms of overall quality, the CPGs ranged from 2.5 to 6.75. The average among all CPGs was 5.2. For domain scores, averaged across all CPGs, domain 5 (applicability) had the lowest average percent score (44%). Domain 4 (clarity of presentation) had the highest average percent score of 82%. Six CPGs only received “yes” votes, and 5 CPGs received at least one “no” vote. Two CPGs received only “no” votes. The inter-rater agreement of domain scoring was excellent (p < 0.001), indicating reliability across raters, domains and CPGs.Conclusions: The 21 CPGs that were identified in this systematic review vary in quality; therefore, we recommended careful scrutiny before their recommendations are adopted. Some domains such as “applicability” scored lower in all CPGs analyzed, revealing opportunity for emphasis and improvement in future CPGs.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/quality-of-clinical-practice-guidelines-on-the-interventional-treatment-of-low-back-pain-a-systematic-review/