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The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
September 1, 2018
Roger Chou et al. (9 authors)
Journal ArticleResearch Support, Non-U.S. Gov'tReviewHuman Study
Study Details

Study Goal

The researchers aimed to develop recommendations for managing spinal disorders, including the role of massage as a conservative treatment for chronic low back and neck pain.

Results Summary

Massage was identified as a primary treatment option for chronic low back and neck pain without serious pathology, alongside other non-pharmacological therapies like exercise and yoga. The study did not provide specific efficacy metrics for massage but included it as a recommended intervention based on synthesized guidelines.

Population

Patients with chronic low back and neck pain without serious pathology, particularly in low-income communities and medically underserved areas.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (30)
InterventionDirectionEndpointPopulationDosageImpactClaim #
education and reassurance
neutral
-
patients with spinal disorders in low-income communities
-
should provide
#1
advice to remain active
neutral
-
patients with spinal disorders in low-income communities
-
should advise
#2
information about self-care options
neutral
-
patients with spinal disorders in low-income communities
-
should provide
#3
exercise
neutral
acute low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary conservative treatment option
#4
manual therapy
neutral
acute low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary conservative treatment option
#5
superficial heat
neutral
acute low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary conservative treatment option
#6
nonsteroidal anti-inflammatory drugs (NSAIDs)
neutral
acute low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary conservative treatment option
#7
exercise
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#8
yoga
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#9
cognitive behavioral therapies
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#10
acupuncture
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#11
biofeedback
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#12
progressive relaxation
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#13
massage
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#14
manual therapy
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#15
interdisciplinary rehabilitation
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#16
NSAIDs
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#17
acetaminophen
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#18
antidepressants
neutral
chronic low back and neck pain without serious pathology
patients with spinal disorders in low-income communities
-
primary treatment option
#19
exercise
neutral
spinal pain with radiculopathy
patients with spinal disorders in low-income communities
-
may consider
#20
spinal manipulation
neutral
spinal pain with radiculopathy
patients with spinal disorders in low-income communities
-
may consider
#21
NSAIDs
neutral
spinal pain with radiculopathy
patients with spinal disorders in low-income communities
-
may consider
#22
benzodiazepines
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#23
botulinum toxin injection
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#24
systemic corticosteroids
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#25
cervical collar
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#26
electrical muscle stimulation
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#27
short-wave diathermy
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#28
transcutaneous electrical nerve stimulation
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#29
traction
no change
spinal pain
patients with spinal disorders in low-income communities
not effective
should not offer
#30
Abstract

PURPOSE: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. METHODS: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. RESULTS: Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. CONCLUSION: Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.

Medical Subject Headings (MeSH)
Developing CountriesHumansLow Back PainNeck PainPatient Education as TopicPractice Guidelines as TopicSelf Care
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations92
Citations/Year13.1
Relative Citation Ratio7.29
NIH Percentile96.3%
Research Impact Scores
APT Score0.95
Weight Score2.46
Normalized Score0.67
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