Evidence-Based Management for Low Back Pain : Quality, Mechanisms and Reporting

Use of the best available evidence is fundamental to provide high-value care for people with low back pain. However, the global burden of low back pain continues to rise, partly attributable to low-value and mismanaged healthcare. The findings from this thesis have provided new data on the quality, mechanisms and reporting of research evidence that informs the care provided to people with low back pain. Chapter Two provided evidence that muscle relaxant medicines, considered first-line pharmacological care by the American College of Physicians guideline, do not provide clinically important improvements in pain and function and are associated with increased risk of experiencing an adverse event in adults with low back pain. Chapter Three and Four highlighted the need and provided recommendations for improved methodological quality and reporting of randomised controlled trials investigating physiotherapy treatments in low back pain. Chapter Five showed that the policies of 10 leading pain journals do not support transparent and open communication of pain research. These findings led to an update in the policies of a leading pain journal. Chapter Six identified how patient education, recommended first-line non-pharmacological care for low back pain, can be adapted to produce clinically important improvements in function. Chapter Seven found suboptimal reporting and methodological limitations in studies conducting mediation analysis in health research. This finding provided evidence for the need to develop a specific reporting guideline for studies conducting mediation analyses. Chapters Eight and Nine describe the development of a guideline for reporting mediation analyses, including a checklist of reporting items derived from an international Delphi exercise.This program of work provides new evidence to improve the evidence-based management of low back pain relating to quality, mechanisms and reporting. The implications for future research and clinical practice are di