A multidisciplinary group of researchers, including physical therapists (PTs), has identified a core set of 11 clinical practice guideline (CPG) recommendations for treating adult musculoskeletal (MSK) pain, according to a new article in British Journal of Sports Medicine (BJSM). Authors hope the recommendations will assist emergency and primary care clinicians in providing evidence-based care, as well as help consumers make informed health care decisions.
Authors write that while “care that is more concordant with CPG recommendations results in better patient outcomes and lower costs,” providers across disciplines too often do not practice according to guidelines, resulting in overuse of imaging, surgery, and opioids, and a failure to provide patient education and advice. There are many reasons for this, according to authors: CPGs often are not “user-friendly”; they often lack guidance on how to implement recommendations in practice; and different guidelines for a single condition may include conflicting recommendations.
Authors of a new clinical practice guideline (CPG) on treatment of shoulder pain took a hard look at the advisability of surgery and came to a conclusion that can be boiled down to 3 words: don’t do it.
Published in BMJ, the CPG focuses on adults with a traumatic shoulder pain lasting for 3 months or more (diagnosed as subacromial pain syndrome, or SAPS), and zeroes in on the effectiveness of arthroscopic decompression surgery versus nonsurgical approaches including exercise therapy, analgesics, and injections. The CPG development group, which included patients who had experienced SAPS, analyzed results of 2 systematic reviews—one on what constitutes a “minimally critically important difference” (MCID) in patient-reported outcomes, and another on the benefits and harms of decompression surgery. The systematic reviews included 7 trials involving 1, 014 patients.
In reviewing the systematic review of MCIDs for SAPS, the CPG group identified, with confidence, 2 changes that patients value: a difference in pain of at least 1.5 points on a visual 1-10 scale, and a difference in function of at least 8.3 units on a 100-point scale. In both areas, decompression surgery resulted in no significant differences from other approaches—including placebo surgery. The lack of difference remained at 6-month, 2-year, and 5-year follow ups.
Experts from 12 European countries now unanimously recommend supervised exercise as a primary intervention for individuals with fibromyalgia. According to an updated clinical practice guideline (CPG) by the European League Against Rheumatism (EULAR) published in BMJ, physical therapy with graded exercise is the only intervention that received the group’s strongest recommendation.
The previous EULAR guideline found very few studies on pharmacologic or nonpharmacologic treatments for fibromyalgia, but that has changed. The current CPG is based on an analysis of 275 published articles and 107 systematic reviews. Authors looked at how well interventions addresseed, pain, fatigue, sleep, and daily functioning, and assigned levels of support for each intervention: “strong against,” “weak against,” “weak for,” and “strong for.”