Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition
Osamu Shirado, Yoshiyasu Arai, Tetsuhiro Iguchi, Shiro Imagama, Mamoru Kawakami, Takuya Nikaido, Tadanori Ogata, Sumihisa Orita, Daisuke Sakai, Kimiaki Sato, Masahiko Takahata, Katsushi Takeshita, Takashi Tsuji, Kei Ando, Yoshiyasu Arai, Teruaki Endo, Hironari Fukuda, Masafumi Goto, Hiroshi Hashidume, Masayuki Hino, Yohei Ide, Tetsuhiro Iguchi, Shiro Imagama, Hirokazu Inoue, Taro Inoue, Yuyu Ishimoto, Kenyu Ito, Sadayuki Ito, Masumi Iwabuchi, Shoji Iwahashi, Hiroshi Iwasaki, Ryohei Kagotani, Shunsuke Kanbara, Kinshi Kato, Mamoru Kawakami, Atsushi Kimura, Tomoko Kitagawa, Hiroshi Kobayashi, Kazuyoshi Kobayashi, Jun Komatsu, Hiroyuki Koshimizu, Masaaki Machino, Tsunemasa Matsubara, Yu Matsukura, Akihito Minamide, Masakazu Minetama, Kenji Mizokami, Tadao Morino, Masayoshi Morozumi, Keiji Nagata, Ichiro Nakae, Masafumi Nakagawa, Yukihiro Nakagawa, Takuya Nikaido, Tadanori Ogata, Sumihisa Orita, Kyotaro Ota, Daisuke Sakai, Kenichiro Sakai, Rikiya Saruwatari, Shinichi Sasaki, Kimiaki Sato, Takahiro Shimazaki, Osamu Shirado, Yasuyuki Shiraishi, Masahiko Takahata, Masanari Takami, Katsushi Takeshita, Satoshi Tanaka, Masatoshi Teraguchi, Ryoji Tominaga, Masaki Tomori, Ichiro Torigoe, Takashi Tsuji, Mikito Tsushima, Shunji Tsutsui, Kazuyuki Watanabe, Hiroshi Yamada, Kei Yamada, Hidetoshi Yamaguchi, Kimiaki Yokosuka, Takanori Yoshida, Tatsuhiro Yoshida, Masato Yuasa, Yasutsugu Yugawa
Abstract
BACKGROUND: The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS: The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS: Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS: The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.