Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.
OBJECTIVE
The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.


METHODS
The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.


RESULTS
For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).


CONCLUSIONS
A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.
['Bussières|André E|AE|', 'Stewart|Gregory|G|', 'Al-Zoubi|Fadi|F|', 'Decina|Philip|P|', 'Descarreaux|Martin|M|', 'Haskett|Danielle|D|', 'Hincapié|Cesar|C|', 'Pagé|Isabelle|I|', 'Passmore|Steven|S|', 'Srbely|John|J|', 'Stupar|Maja|M|', 'Weisberg|Joel|J|', 'Ornelas|Joseph|J|']
D000328:Adult D002170:Canada D002684:Chiropractic D000529:Complementary Therapies D000072700:Conservative Treatment D019317:Evidence-Based Medicine D006801:Humans D017116:Low Back Pain D020393:Manipulation, Spinal D016032:Randomized Controlled Trials as Topic D000078202:Systematic Reviews as Topic D016896:Treatment Outcome
Conservative Treatment Low Back Pain Chiropractic Practice Guideline Disease Management