Low-value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines.
Daniel Tai, Eunyeop Kim, Prateek Grover and 3 others
PMID 39444252WHAT IT FOUND
Guidelines recommend stopping traction, TENS, therapeutic ultrasound, and SSRIs for low back pain.
These treatments were flagged as low-value by five or more guidelines. Clinicians should consider deimplementing them to avoid unnecessary care.
Key findings
01Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRIs) were recommended strongly against by five or more clinical practice guidelines.
02A total of 135 low-value recommendations for deimplementation were identified across eight intervention categories, including orthotics, injections, and bed rest.
03Higher-quality guidelines did not differ significantly from lower-quality guidelines in their specific recommendations against these low-value interventions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The analysis was limited to guidelines published in English, which may bias the findings toward Western practices. Guidelines were grouped into high and low quality based on an arbitrary score threshold (5.20), which may not reflect true confidence in their recommendations. Recommendations with 'inconclusive' or 'insufficient evidence' were not analyzed, potentially missing other low-value practices. The crosswalk table used to standardize recommendation strength has not been externally validated.
Declared interests
The authors have no conflicts of interest to disclose.
The easy way to misread this
Do not assume that higher-quality guidelines are more aggressive about stopping low-value care. The study found no significant difference in deimplementation recommendations between higher- and lower-quality guidelines, meaning quality ratings do not predict which treatments are flagged as low-value.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →