[Recommendations on care of back pain problems]

Abstract

Back problems are a common cause of disability. There are important variations in the care provided, suggesting that some patients receive suboptimal treatment. Several Western countries have developed practice guidelines to improve this state of affairs. If guidelines are to improve the outcome for patients seeking care, they must give valid recommendations. In this article I compare ten practice guidelines for back problems. The guidelines are from nine Western countries and were published in the ten-year period 1987-97. There are significant variations in the recommendations given. The guidelines were developed according to different methods. A systematic, evidence-based approach is less prone to bias than an informal expert-based consensus. I conclude that the systematically developed US guideline (AHCPR 1994) and the British guideline (RCGP 1996) are the ones giving valid recommendations and are therefore the best options for practitioners.