Het beleid bij lage-rugpijn. Aen vergelijking van nationale richtlijnen uit vier landen

Translated title of the contribution: The management of low back pain. A comparison of national guidelines in four countries

B. W. Koes*, M. W. Van Tulder

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

Abstract

Background: Recently, clinical practice guidelines for the management of low back pain have been published in the United States, the United Kingdom, New Zealand and the Netherlands. The aim of this study was to compare the background and content of these guidelines with regard to the diagnostic and therapeutic recommendations. Results: The content of the guidelines appeared to be quite similar regarding the diagnostic classification and the recommendations for diagnosis as well as the recommendations for treatment. In summary, all guidelines recommend that the diagnostic management should be aimed at excluding specific pathology, including a lumbosacral radicular syndrome. It is emphasized that the natural course or prognosis of non-specific low back pain is quite good. The therapeutic management is aimed at advising the patient to continue with his/her normal activities as good as possible. Analgesics can be prescribed to help increase the activities. If the symptoms still persist after 6 weeks, and there is no specific pathology, the patient might be advised to exercise at home or be referred to exercise therapy. Prevention of persistent disability is the most important aim of the management at this stage. There are few discrepancies regarding the therapeutic management recommended in the four international guidelines. In the US-guidelines but not in the other guidelines, exercise therapy is recommended in the acute phase (low back pain less than 6 weeks). In the Dutch guidelines it is stated that spinal manipulation is not a useful treatment for acute low back pain, while in the other three guidelines spinal manipulation for acute low back pain is recommended. All four guidelines are developed for primary health care, but the Dutch guidelines more exclusively focus on general practice. The evidence for the effectiveness of diagnostic and therapeutic interventions used in the guidelines is based on extensive literature reviews. All four guidelines are easily accessible for the professional groups that they aimed at. The Dutch, US and UK guidelines are accompanied by a patient brochure. The Dutch guidelines will regularly be updated. In the UK and New Zealand updates are planned 2 years after the date of publication. There are no plans for an update of the US guidelines. Discussion: The implementation of the guidelines is not systematically supported. Implementation of the Dutch guidelines is facilitated by promotion of expertise through the National Association of General Practitioners ('Landelijke Huisartsen Vereniging'), but it is unclear if this strategy is successful. If, in the near future, the guidelines will be updated when more evidence becomes available, the discrepancies between the four guidelines might be resolved.

Translated title of the contributionThe management of low back pain. A comparison of national guidelines in four countries
Original languageDutch
Pages (from-to)57-61+68
JournalHuisarts en Wetenschap
Volume41
Issue number2
Publication statusPublished - 1 Dec 1998

Keywords

  • Clinical guidelines
  • Family practice
  • Low back pain, diagnosis, therapy
  • Primary care

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