Authors' objectives: Low back disorders (LBD) are an exceedingly common complaint, with a lifetime prevalence ranging from 54-80%. Chronic low back pain may be seen in 25-60% of patients one year or longer after an initial episode. The economic impact of low back pain is substantial. It is the fifth most common reason for all physician visits in the U.S., and is responsible for direct medical costs that approach $30 billion annually. In addition, low back pain is a major cause of lost productivity; it is estimated that 2% of the U.S. work force is compensated for back pain or injury each year. This appraisal will evaluate the evidence on the comparative risks, benefits, and cost-effectiveness of multiple management strategies for patients with chronic low back pain (i.e., >4 weeks' duration) without evidence of systemic disease or significant neurological findings.

Authors' recommendations: Evidence is conflicting on whether the clinical outcomes of Interdisciplinary Rehabilitation Programs (IRP) are superior to those of well‐delivered physical therapy; it is also unknown whether there are specific components of these programs that are more important for successful outcomes - There is insufficient evidence to determine whether any form of spinal injection provides a net clinical benefit over simple conservative care: - This is also true for most minimally‐invasive procedures   - For patients with lumbar disc herniation, surgery produces earlier improvements in pain and function than conservative care, but by 1‐2 years patients treated conservatively "catch up" and achieve very similar overall outcomes - There is good evidence that, among patients with lumbar spinal stenosis and degenerative spondylolisthesis, surgery produces moderate clinical improvements over conservative care that persist through 2 years of follow‐up  

Project Status: Completed

URL for project: http://www.icer-review.org/lbp-appraisal-052010/

Year Published: 2011

URL for published report: http://www.icer-review.org/wp-content/uploads/2013/04/Low-Back-Disorders-Final-Appraisal-Document.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical and Economic Review

Contact Address: 101 Merrimac St., 10th FL., Boston MA, USA 02114, Tel: (617) 724-4445 , Fax: (617) 726-9414

Contact Name: info@icer-review.org

Contact Email: info@icer-review.org

Copyright: Institute for Clinical and Economic Review (ICER)