What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review

ObjectivesTo identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quali...

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Bibliographic Details
Published in:British journal of sports medicine 2020-01, Vol.54 (2), p.79-86
Main Authors: Lin, Ivan, Wiles, Louise, Waller, Rob, Goucke, Roger, Nagree, Yusuf, Gibberd, Michael, Straker, Leon, Maher, Chris G, O’Sullivan, Peter P B
Format: Article
Language:English
Subjects:
Arthritis
Back pain
Classification
Clinical decision making
Clinical medicine
Clinical practice guidelines
Decision making
Education
Evidence-Based Medicine
Humans
Jargon
Knee
Musculoskeletal Pain - therapy
Narcotics
Patients
Practice Guidelines as Topic
Quality
Quality of Health Care
Rotator cuff
Stakeholders
Surgery
Surgical outcomes
Systematic review
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Summary:ObjectivesTo identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).DesignSystematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.Eligibility criteriaIncluded MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sourcesFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.Results6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.ConclusionThese 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.
ISSN:0306-3674
1473-0480
DOI:10.1136/bjsports-2018-099878