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“Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain”
“Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for knee pain”
“Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain”
“Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for shoulder pain”
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
INTRODUCTION: A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back, neck, knee, and shoulder pain.
METHODS: Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analyses were conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies.
DEVELOPING RECOMMENDATIONS: An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established.
VALIDATING THE RECOMMENDATIONS: A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%.
RESULTS: Eight positive recommendations of clinical benefit were developed. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 75% agreement). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation, mechanical traction), there was a lack of evidence regarding efficacy.
CONCLUSIONS: This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing EBCPGs that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions where evidence was insufficient to make recommendations.
These two articles on PainScience.com cite Philadelphia Panel 2001 as a source:
- PS Pseudo-Quackery in the Treatment of Pain — The large, dangerous gray zone between evidence-based care and overt quackery in musculoskeletal and pain medicine
- PS Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.
- Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Zhong 2017 Pain Physician.