Current understanding of back pain management

Using the framework of clinical practice guidelines, O’Connell et al. provide a synthesis of current evidence for the treatment of back pain. Recent updates of major international guidelines published in the UK and Canada provide the opportunity to overview the state of research regarding treatment effectiveness. Along with this synopsis, the methods of guideline development are appraised and critical commentary provided on the various processes. This offers clinicians an insight into how recommendations are made and facilitates their own appraisal of clinical practice guidelines. Alongside clinical effectiveness, issues of cost-effectiveness are important drivers of healthcare practice. Van Dongen et al. collect the current evidence for the cost-effectiveness of treatments for back pain to provide a systems perspective to the edition and give readers an overview of this key input into policy. Their methodological overview identifies gaps in our knowledge and describes priorities and guidance for future research efforts. As the past few decades have seen a move towards understanding back pain from a behavioural perspective, so have self-management and behaviour change interventions become increasingly recommended. Mansell et al. review the evidence regarding the effectiveness of these types of interventions and describe the theoretical and operational processes that underpin their development. Reliable and valid measurement of outcome is fundamental to the operation of evidence-based healthcare. Ensuring optimal and standardised choice of outcome measures enables reliable evaluation of care and provides a common language across clinical and research settings. Chiarotto et al. report on international consensus regarding choice of outcome measures for research and practice and outline the basis for these recommendations. The findings are directly and immediately applicable to clinicians and researchers in the field.