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Overviews and Systematic Reviews on Low Back Pain
- Roger Chou, MD;
- Paul Shekelle, MD, PhD;
- Amir Qaseem, MD, PhD, MHA; and
- Douglas K. Owens, MD, MS
- From Oregon Health & Science University, Portland, OR 97239; Veterans Affairs Health Care System and RAND Corporation, Santa Monica, CA 90401; American College of Physicians, Philadelphia, PA 19106; Stanford University, Stanford, CA 94305.
IN RESPONSE:
We thank the authors of the letters for their comments on our low back pain guideline (1) and evidence reviews (2, 3). Dr. Bjordal and colleagues note some methodological concerns with our review on medications for acute and chronic low back pain. To clarify, we performed a systematic review of a broad range of systematic reviews and included past systematic reviews when they were available and of sufficient quality. The idea that new systematic reviews of the primary literature should always be conducted when developing clinical practice guidelines is both unsupported by any empirical evidence and could be a poor use of scientific resources (4). Guideline panels need relevant, current, high-quality reviews of the evidence; if existing reviews fulfill those criteria, then it is wasteful to ignore them and conduct new ones. We included systematic reviews published in or after 2000 and identified higher-quality reviews by using a validated, quality-rating instrument (5, 6). Although systematic reviews should be updated, there is no compelling reason to ignore higher-quality Cochrane reviews (7) that satisfied our methodological criteria for inclusion but did not meet an updating deadline (8). Dr. Bjordal and colleagues suggest that we …
