Session Information
Session Title: AA 2022 Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Daniel Tai: No financial relationships or conflicts of interest
Background and/or Objectives: Low back pain (LBP) clinical practice guidelines (CPG) that resulted from a systematic review (SR) were analyzed to identify treatment recommendations that were recommended against. These consolidated recommendations were considered low-value care practices that are appropriate for de-implementation.
Design: LBP (sub-acute or chronic) CPGs in English (symptom-based, governmental or professional society created, between January 1990 and May 2020) were found using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, ECRI, Guidelines International Network, NICE, and SIGN. CPGs used in this analysis resulted from an SR and were quality appraised as previously described. Full-text reviews of all 21 CPGs were conducted and de-implementation recommendations were organized into three categories (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) with the aid of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Setting: Literature review
Participants: Literature review
Interventions: not applicable
Main Outcome Measures: Low-value recommendations, category of recommendations, strength of recommendations (strongly against versus weakly against), association between quality of CPG and specific de-implementation recommendation (p < 0.05), and association between quality of CPG and strength of recommendations (p < 0.05).
Results: 135 low-value recommendations spanning 8 treatment categories were identified: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation, therapeutic ultrasound, and selective serotonin reuptake inhibitors had the most CPGs recommend strongly against their usage. Four CPGs strongly recommended against opioids. No significant differences (p>0.05) were found between the quality of CPG and a specific de-implementation recommendation and in the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations between higher-quality and lower-quality CPGs.
Conclusions: We recommend that clinicians managing patients with chronic LBP consider de-implementing these low-value recommendations based on their practice and patient needs.
Level of Evidence: Level I
To cite this abstract in AMA style:
Tai D, Annaswamy TM, Kim E, Rodriguez A, Olivier T. Low-value Interventions to De-implement: Systematic Review of Low Back Pain Clinical Practice Guidelines [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/low-value-interventions-to-de-implement-systematic-review-of-low-back-pain-clinical-practice-guidelines/. Accessed May 23, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/low-value-interventions-to-de-implement-systematic-review-of-low-back-pain-clinical-practice-guidelines/