Network meta-analysis for comparative effectiveness of treatments for chronic low back pain disorders: systematic review protocol

BMJ Open. 2021 Nov 29;11(11):e057112. doi: 10.1136/bmjopen-2021-057112.


Introduction: Chronic low back pain disorders (CLBDs) present a substantial societal burden; however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated individual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, 'usual care' and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs.

Methods and analysis: Six electronic databases and reference lists of 285 prior systematic reviews were searched. Eligible studies will be randomised controlled/clinical trials (including cross-over and cluster designs) that examine individual treatments or treatment combinations in adult patients with CLBDs. Studies must be published in English, German or Chinese as a full-journal publication in a peer-reviewed journal. A narrative approach will be used to synthesise and report qualitative and quantitative data, and, where feasible, network meta-analyses will be performed. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, including the network meta-analysis extension (PRISMA-NMA). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for network meta-analysis will be implemented for assessing the quality of the findings.

Ethics and dissemination: Ethical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication.

Prospero registration number: PROSPERO registration number CRD42020182039.

Keywords: back pain; pain management; rehabilitation medicine; spine.

MeSH terms

  • Adult
  • Exercise
  • Humans
  • Low Back Pain* / therapy
  • Meta-Analysis as Topic
  • Network Meta-Analysis
  • Pain Management
  • Physical Therapy Modalities
  • Systematic Reviews as Topic