THE REVISED DUTCH GUIDELINE FOR PHYSICAL THERAPY ON LOW BACK PAIN AND LUMBOSACRAL RADICULAR SYNDROME

N. Swart¹, A. Apeldoorn², D. Conijn¹, G. Meerhoff¹, R. Ostelo³

¹Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands, ²Noordwest Ziekenhuisgroep, Rehabilitation Department, Alkmaar, Netherlands, ³VU University Amsterdam, Amsterdam Movement Sciences (AMS) Research Institute, Amsterdam, Netherlands

Background: Since the publication of the KNGF guideline on low back pain in 2013, new insights have been obtained from daily practice and scientific evidence regarding diagnosing and treating patients with low back pain and lumbosacral radicular syndrome (LRS). A revision of the guideline was necessary to be able to offer patients with low back pain and LRS targeted treatment at the right time within the healthcare process.

Purpose: The aim of this project was to provide up to date evidence-based recommendations on low back pain and LRS to supports physical therapists and patients in the clinical decision-making process. A secondary aim was to offer transparency to other healthcare providers and stakeholders.

Methods: A guideline panel (n=18) and review group (n=14) with representatives of relevant stakeholders (for example physical therapists, general practitioner, occupational physician, neurologist, and patients) was composed. Clinical questions were formulated after focus groups with patients and physical therapists and consultation of experts. Thereafter, narrative or systematic reviews were performed. The evidence was synthesized by providing the estimates of the effect for each outcome (between group differences; e.g. (standardized) mean differences) and the quality of the evidence using the approach developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. A strong or conditional recommendation for or against an intervention was formulated by the panel, based on scientific evidence, patient preferences, costs/resources, inequity, feasibility, and acceptability using the GRADE evidence to decision framework. The final guideline has been submitted to the relevant stakeholders for authorization.

Results: The revised KNGF guideline for low back pain and LRS was published in October 2021.
Physical therapists are recommended to evaluate thirteen prognostic factors for persistent complaints upon initial contact with the patient.
In patients with a low risk of persistent complaints information and advice is strongly recommended and exercise therapy without supervision of a physical therapist is weakly recommended. Manipulations and mobilisations are not recommended in these patients.
In patients with a moderate risk of persistent complaints information and advice and exercise therapy with the supervision of a physical therapist are strongly recommended. A weak recommendation to consider mobilisation and/or manipulation is formulated, under weighted conditions as a supplement to exercise.
In patients with a high risk of persistent complaints information and advice is strongly recommended. Also, a weak recommendation to consider behaviour-oriented treatment to optimise physical activity and participation in patients with dominant (psychosocial) prognostic factors is formulated.
In addition, specific recommendations on the management of LRS are formulated.

Conclusions: Easy to use and up to date recommendations on the management of low back pain and LRS are provided based on international standards for guideline development. The guideline encourages an active approach, self-management and targeted treatment with customised treatment recommendations based on individual risk factors.

Implications: The guideline is approved by all relevant stakeholders, allowing implementation within the healthcare process. Based on an implementation plan different implementation strategies are deployed to enhance the uptake of the recommendations in daily practice.

Funding acknowledgements: The guideline was financially supported by the KNGF and the Dutch Ministry of Health, Welfare and Sports.

Keywords:
Low back pain
Physical therapy
Guidelines

Topics:
Musculoskeletal: spine
Research methodology, knowledge translation & implementation science
Globalisation: health systems, policies & strategies

Did this work require ethics approval? No

Reason: Ethics approval was not required for the development of this guideline since no individual patient data were used.