What Does Best Practice Care for Musculoskeletal Pain Look Like? Eleven Consistent Recommendations From High-quality Clinical Practice Guidelines: Systematic Review

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SOURCE:   British J Sports Medicine 2020 (Jan); 54 (2): 79–86
Ivan Lin, Louise Wiles, Rob Waller, Roger Goucke, Yusuf Nagree, Michael Gibberd, Leon Straker, et. al.

WA Centre for Rural Health,
University of Western Australia,
Geraldton, Western Australia, Australia.

      Lancet Digit Health 2022

Objectives:   To 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).

Design:   Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.

Eligibility criteria:   Included 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.

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Data sources:   Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.

Results:   6,232 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.

Conclusion:   These 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

Keywords:   education; effectiveness; evidence based; knowledge translation; review.

From the FULL TEXT Article:


Box 1

Musculoskeletal pain (MSK) conditions are the biggest cause of disability internationally [1] and a major societal burden. One contributor to this burden, which is becoming increasingly recognised, is poor quality healthcare. [2] Common healthcare problems for MSK pain are summarised in Box 1 and include overuse of radiological imaging, surgery and opioids and a failure to provide patients with education and advice.

Evidence-to-practice gaps such as these are problematic because they waste healthcare resources and prevent patients from receiving appropriate care.

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