Article type
Year
Abstract
Introduction: There are many treatment options for acute low back pain, but little is known about the optimal treatment strategy.
Objective: To systematically evaluate the efficacy of the most common therapeutic interventions for acute low back pain.
Methods: A systematic computerized literature search in the MEDLINE, EMBASE and PsycLIT databases was conducted, and studies were included in the review if the interventions were randomly allocated, if the results (exclusively or separately) concerned patients with acute low back pain and if the article was published in English. A rating system was used to assess the strength of the evidence, based on the methodological quality of the randomized clinical trials, the relevance of the outcome measures and the consistency of the results.
Results: 81 Trials of 11 interventions were included in the review. The number of trials varied widely with regard to the interventions involved. In general, the methodological quality of the trials was poor; only 35% of the trials were considered to be of high quality. Various methodological flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and NSAIDs. The evidence in favor of other conservative types of treatment was only moderate or limited due to the low methodological quality of the trials involved. For some interventions no evidence at all was found due to the contradictory results.
Discussion: There is much room for improvement of the quality of the design, execution and reporting of randomized clinical trials. A rating system for summarizing the available evidence on the basis of randomized clinical trials may be a useful tool in future systematic reviews. We suggest that the validity of the trials, the relevance of the outcome measures and the consistency of the results should be incorporated in such a rating system.
Objective: To systematically evaluate the efficacy of the most common therapeutic interventions for acute low back pain.
Methods: A systematic computerized literature search in the MEDLINE, EMBASE and PsycLIT databases was conducted, and studies were included in the review if the interventions were randomly allocated, if the results (exclusively or separately) concerned patients with acute low back pain and if the article was published in English. A rating system was used to assess the strength of the evidence, based on the methodological quality of the randomized clinical trials, the relevance of the outcome measures and the consistency of the results.
Results: 81 Trials of 11 interventions were included in the review. The number of trials varied widely with regard to the interventions involved. In general, the methodological quality of the trials was poor; only 35% of the trials were considered to be of high quality. Various methodological flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and NSAIDs. The evidence in favor of other conservative types of treatment was only moderate or limited due to the low methodological quality of the trials involved. For some interventions no evidence at all was found due to the contradictory results.
Discussion: There is much room for improvement of the quality of the design, execution and reporting of randomized clinical trials. A rating system for summarizing the available evidence on the basis of randomized clinical trials may be a useful tool in future systematic reviews. We suggest that the validity of the trials, the relevance of the outcome measures and the consistency of the results should be incorporated in such a rating system.