Quality of clinical practice guidelines on interventional management of low back pain: A systematic review

Timothy J. Olivier, Becky Baltich Nelson, Tri Pham, Kavita Trivedi, Ankit Patel, G. Sunny Sharma, Chaitanya Konda, Thiru M. Annaswamy

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Objective: To appraise the quality of low back pain (LBP) clinical practice guidelines (CPG) that include interventional management recommendations and to associate their quality with characteristics including publication year and creating organization. Type: Systematic Review. Literature Survey: LBP (subacute or chronic) CPGs in English (symptom based, governmental or professional society created, January 1990-May 2020) were found using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, ECRI, Guidelines International Network, NICE, and SIGN. Methodology: In this third order systematic review, search results were deduplicated, title and abstract screened by two independent reviewers, and full texts reviewed by four reviewers. Discrepancies were resolved by a third reviewer. Resulted CPGs were appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool by four appraisers each. Association of their quality with creating organization, geographical region, and year of creation was calculated. Synthesis: Seven hundred fourteen screened documents resulted in 21 final CPGs. On appraisal, average overall CPG quality was 5.2 (range 2.5-6.75). Domain 5 (applicability) had the lowest average (44%) and domain 4 (clarity of presentation) had the highest average score (82%). For overall recommendation, 16 received “yes” or “yes with modifications,” six received unanimous “yes” and two unanimous “no” votes. The interrater agreement of domain scoring was excellent (0.8-1.0; p <.001). There was no association found between quality of CPG and (1) year of publication (R2 = 0.0006), (2) whether the CPG was updated or new (p =.17), and (3) region of publication (p =.37). Conclusions: The majority of the 21 CPGs identified in this systematic review were of high quality, but overall quality and recommendation ratings were variable. The quality of appraised CPGs showed no association with their characteristics. Some domains such as “applicability” scored uniformly lower, revealing opportunity for improvement in future CPG development. LBP CPGs should be scrutinized before adopting their recommendations.

Original languageEnglish (US)
Pages (from-to)1038-1051
Number of pages14
JournalPM and R
Issue number8
StatePublished - Aug 2023

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Neurology
  • Clinical Neurology


Dive into the research topics of 'Quality of clinical practice guidelines on interventional management of low back pain: A systematic review'. Together they form a unique fingerprint.

Cite this