Article Text

other Versions

Download PDFPDF
Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review
  1. Ivan Lin1,
  2. Louise K Wiles2,
  3. Robert Waller3,
  4. Roger Goucke4,
  5. Yusuf Nagree5,6,
  6. Michael Gibberd7,
  7. Leon Straker3,
  8. Christopher G Maher8,
  9. Peter P B O’Sullivan3
  1. 1Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
  2. 2Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
  3. 3School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
  4. 4Western Australian Pain Management Centre, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
  5. 5Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
  6. 6Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  7. 7Emergency Department, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
  8. 8Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Ivan Lin, Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, 6531, Australia; ivan.lin{at}


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).

  • effectiveness
  • evidence based
  • knowledge translation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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 and major project is funded by Australia’s National Health and Medical Research Council (APP1103022 and APP1113532). 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.