Content and quality appraisal of clinical practice guidelines for the non-pharmacological management of low back pain: a systematic review

Hui Yeung Mak, Ting Ho Lim, Ngai See Moriah Man, Yeuk Tsin Man, Ching Ho Tang, Yu Lok Wong, André Bussières, Fadi Mohammad Qassim Al Zoubi

Research output: Unpublished conference presentation (presented paper, abstract, poster)Conference presentation (not published in journal/proceeding/book)Academic researchpeer-review


Background and purpose:
As a prevalent condition, low back pain (LBP) burdens the global healthcare system. The aim of this systematic review is to summarize and critically appraise recent clinical prac- tice guidelines (CPGs) on non-pharmacological manage- ment of LBP.
Six electronic databases and seven guideline clearinghous- es were searched for CPGs on LBP published between January 1, 2012 and December 20, 2022. Five reviewers in- dependently screened citations for eligible CPGs and ex- tracted the contents of guidelines that were admissible. The quality of the CPGs was then independently appraised by five reviewers using the AGREE II and AGREE-REX. The intraclass correlation coefficient was used to calculate in- ter-rater agreement for each domain and total score (ICC [2,1]).
We screened 21,427 citations from database searches and 21 from guideline clearinghouse websites, yielding 21 eligi- ble CPGs (10 non-specific LBP, 8 LBP with radiculopathy, 2 with disc herniation, and 1 isthmic spondylolisthesis) from 12 countries. Ten CPGs were rated as high quality by AGREE II. Seven CPGs were classified as high quality by AGREE-REX. The ICC values for both tools were excellent. The majority of CPGs recommend multimodal interventions, which main- ly include exercises, education, and cognitive behavioural therapies. The majority of the CPGs were found to have sig- nificant methodological limitations in the domains of Appli- cability in AGREE-II and Implementability in AGREE-REX.
As the majority of the CPGs recommend multimodal ap- proaches, trials comparing the effectiveness of these ap- proaches are needed. CPG developers should make every effort to minimize methodological flaws during develop- ment.
Original languageEnglish
Number of pages1
Publication statusPublished - 24 Jun 2023
EventHong Kong Physiotherapy Association 60th Anniversary Conference - Tsuen Wan , Hong Kong
Duration: 24 Jun 202324 Jun 2023


ConferenceHong Kong Physiotherapy Association 60th Anniversary Conference
Country/TerritoryHong Kong
CityTsuen Wan


  • Clinical practice guidelines
  • Low Back Pain
  • Systematic review


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