Acute Lower Back Problems in Adults - Efficacy

Evaluation of Efficacy

In evaluating efficacy of assessment and treatment methods, the panel decided to focus on how each method affected clinical outcomes important to patients and society. Examples of such outcomes are symptoms, level of physical functioning, patient satisfaction, and morbidity and mortality (as complications of the assessment or treatment method). The panel dealt with costs, another outcome of interest to patients and society, as a separate issue. Cost was not considered when evaluating efficacy.

The panel used a standard methodology to identify and evaluate the best scientific evidence available on the efficacy of each assessment and treatment method, while focusing on clinical outcomes. This process included a systematic evaluation of each study's quality and its clinical applicability to patients with acute low back problems. The panel used this information to screen all articles, using minimum article selection criteria for efficacy. Articles meeting these minimum criteria were prioritized (giving priority to articles of higher quality and clinical applicability), and data from the higher priority articles were abstracted onto evidence tables.

The panel then reviewed the available data from both evidence tables and original articles to decide how much weight to give each study in developing the findings and recommendations statements for this guideline. The greatest weight was given to studies of high quality that evaluated adults with acute low back problems, although few such studies were found.

For most topics, the quality and clinical applicability of studies reviewed were limited. Inclusion and exclusion criteria for subjects were often either incompletely described or so broad that they allowed for wide variations in age, symptoms, symptom duration, examination findings, prior treatments, and other potentially confounding factors. Studies often inadequately described the baseline demographic and clinical characteristics of subjects. Many studies did not distinguish acute from chronic patients; others failed to either describe or control for factors known to cause significant variation in outcome (such as prior back surgery). Certain studies lacked appropriate statistical analysis or included too few subjects to attain adequate statistical power.

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.