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What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review
  1. Ivan Lin1,
  2. Louise Wiles2,
  3. Rob Waller3,
  4. Roger Goucke4,
  5. Yusuf Nagree5,6,
  6. Michael Gibberd7,
  7. Leon Straker8,
  8. Chris G Maher9,
  9. Peter P B O’Sullivan10
  1. 1 WA Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
  2. 2 Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
  3. 3 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  4. 4 Pain Management Centre, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
  5. 5 Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
  6. 6 Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  7. 7 Emergency Department, Geraldton Hospital, Geraldton, Western Australia, Australia
  8. 8 School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
  9. 9 School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  10. 10 Department of Physiotherapy, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Ivan Lin, WA Centre for Rural Health, University of Western Australia, Western Australia, 6531, Australia; ivan.lin{at}


Objectives To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).

Design Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.

Eligibility criteria Included MSK pain CPGs were written in English, rated as high quality, published from 2011, 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 Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.

Results 6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.

Conclusion These 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

  • education
  • effectiveness
  • evidence based
  • knowledge translation
  • review

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  • Contributors All authors were involved in the conception, design and interpretation of data. IL, LW and RW performed the data analysis and initial interpretation. IL was responsible for initial writing and drafting of the article, which was reviewed by all authors. All authors revised critically for important intellectual content and approved the final version to be submitted.

  • Funding IL is funded by an Australian National Health and Medical Research Council Early Career Fellowship (APP1090403). CGM’s fellowship (APP1103022) is funded by Australia’s National Health and Medical Research Council, and his research is supported by a Program Grant (APP1113532) and CRE Grant (APP1134856). LW works on a project funded by a National Health and Medical Research Council Program Grant (APP1054146).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.