The University of Southampton
University of Southampton Institutional Repository

Inconsistent grading of evidence across countries: a review of low back pain guidelines

Murphy, Audrey Y.M.T., van Teijiligen, Edwin R. and Gobbi, Mary O. (2006) Inconsistent grading of evidence across countries: a review of low back pain guidelines Journal of Manipulative and Physiological Therapeutics, 29, (7), pp. 576-581. (doi:10.1016/j.jmpt.2006.07.005).

Record type: Article


Objective The aim of this study was to report clinical treatment recommendations for low back pain (LBP) based on 5 international guidelines and best evidence from the Cochrane database of systematic reviews.
Methods Five LBP guidelines available in English language were appraised, including 4 studies published since the seminal work by Koes et al (Spine 2001;26:2504-5213). The guidelines were examined for treatment recommendations concerning nonspecific LBP and guideline quality with application of the Appraisal of Guidelines for Research and Evaluation instrument. Secondly, a systematic literature search for reviews and randomized controlled trials was conducted using a modified version of the search strategy recommended by the Cochrane Back Review Group. Two systematic reviews were identified.
Results According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP.
Conclusion Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.

Full text not available from this repository.

More information

Submitted date: March 2006
Published date: September 2006
Keywords: low back pain, LBP, Cochrane database, systematic reviews, spinal manipulation


Local EPrints ID: 42502
ISSN: 0161-4754
PURE UUID: 96298ca0-4a88-48bd-805d-10e9e6743461

Catalogue record

Date deposited: 15 Dec 2006
Last modified: 17 Jul 2017 15:21

Export record



Author: Audrey Y.M.T. Murphy
Author: Edwin R. van Teijiligen
Author: Mary O. Gobbi

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.