Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF).
Adri T Apeldoorn, Nynke M Swart, Daniëlle Conijn and 2 others
PMID 38407016WHAT IT FOUND
Screen low back pain patients for factors that predict slow recovery, match treatment intensity to risk, use exercise therapy, and use mobilization or manipulation only as add-ons, not stand-alone care.
Key findings
01The guideline advises physical therapists to assess prognostic factors such as leg pain, high pain intensity, fear of movement, depression, passive coping, negative expectations, high physical work load, poor relationships with colleagues and diminished job satisfaction before choosing treatment intensity.
02Exercise therapy showed a clinically relevant short-term effect for chronic low back pain, but no clinically relevant effect for acute or subacute low back pain.
03Mobilization or manipulation should be considered only as a supplement to exercise therapy, not as a stand-alone treatment, and preferably not for lumbosacral radicular syndrome.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This article discusses only a selection of the guideline's clinical questions, so the full guideline is needed for complete recommendations. Many underlying systematic reviews were of low or critically low quality, and the certainty of evidence was often very low or low. The treatment profiles are based on the physical therapist's individual judgement and still require further development. The evidence on prognostic factors is inconsistent, and there is little information about factors that predict good recovery. For mobilization and manipulation, most studies included mixed patients with or without lumbosacral radicular syndrome, so the guideline could not adequately compare effects in radicular patients. The guideline did not systematically search observational studies or non-controlled trials.
Declared interests
The authors declared no financial conflicts. The guideline was co-financed by the Ministry of Health, Welfare and Sport, the Royal Dutch Society for Physical Therapy and the Cesar en Mensendieck Therapists Association.
The easy way to misread this
Do not read the manual therapy recommendation as proof that mobilization or manipulation works for sciatica. The evidence was mostly small and of very low certainty, and the guideline says not to use them as a stand-alone treatment and preferably not for patients with lumbosacral radicular syndrome.