Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

Ivan Lin, Louise K. Wiles, Robert Waller, Roger Goucke, Yusuf Nagree, Michael Gibberd, Leon Straker, Christopher G. Maher, Peter P. B. O'Sullivan

Research output: Contribution to journalReview articlepeer-review

57 Citations (Scopus)
381 Downloads (Pure)


Objectives Undertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.

Design Systematic review of CPGs (PROSPERO number: CRD42016051653). Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.

Data sources and method of appraisal Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.

Results 4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n= 12) or low back pain (n= 11), most commonly from the USA (n= 12). The mean overall AGREE II score was 45% (SD= 19.7). Lowest mean domain scores were for applicability (26%, SD= 19.5) and editorial independence (33%, SD= 27.5). The highest score was for scope and purpose (72%, SD= 14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n= 4), low back pain (n= 2), neck (n= 1) and shoulder pain (n= 1).

Original languageEnglish
Article numbere098375
Pages (from-to)337-343
Number of pages7
JournalBritish Journal of Sports Medicine
Issue number5
Publication statusPublished - 1 Nov 2018


Dive into the research topics of 'Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review'. Together they form a unique fingerprint.

Cite this