NICE guidance on low back pain & sciatica: #physiotalk Monday 18 April 2016

??????????????????????????????????????????????????????????????????????????????????????On Monday 18th April at 8pm UK-time we will be joining with Steve Nawoor, Roger Kerry, Chris McCarthy and Chris Mercer for a #physiotalk tweetchat on the draft NICE guidance on low back pain and sciatica. We’re aiming to facilitate constructive discussion on the draft recommendations, tackle some myths about NICE guidance in general, and highlight how you can get involved in the consultation and more broadly in the work of NICE. 

National Institute for Health and Care Excellence (NICE)

NICE’s role is to improve outcomes for people using the NHS and other public health and social care services.  They do this by:

  • Producing evidence based guidance and advice.
  • Developing quality standards and performance metrics.
  • Providing a range of informational services including NICE Evidence.

The way NICE was established in legislation means that NICE guidance is officially England-only. However, there are agreements to provide certain NICE products and services to Wales, Scotland and Northern Ireland.

Updated guidance

NICE is updating its 2009 guidance on the early management of low back pain and published draft recommendations on the 24th March. This draft guidance is currently open to public consultation until 5th May 2016 and has already created significant online discussion within the physiotherapy and musculoskeletal community.

Some key changes from the guidance 2009 include:

  • Expanded scope to include people with sciatica and to cover people with low back pain or sciatica irrespective of how long they have had the condition.
  • Exercise, in all its forms as the first step in managing low back pain.
  • Massage and manipulation should only be used alongside exercise.
  • Acupuncture no longer recommended for treating non-specific low back pain.
  • Combined physical and psychological treatments are recommended for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.

As always with NICE guidance we should suggest going straight to the published draft recommendations before entering into on and off-line discussions. The short version contains just the draft recommendations, while the draft guidelines parts 1 and 2 contain methods, evidence and recommendations.

Some questions to think about before the chat:

  1. Compliance? Adherence? Use? Implementation? Is there clear, consistent and accurate understanding of the role and use of NICE guidance within the physiotherapy community?
  2. Which of the draft recommendations could have the biggest impact on physiotherapy practice, services – and most importantly on patients?
  3. How well do the recommendations reflect what the evidence says?
  4. Which draft recommendations would be the most challenging to implement/put into practice and why?
  5. How relevant are these guidelines to physiotherapists working outside of the NHS, or for the NHS outside of England?
  6. Do you know how to get involved and influence this draft guideline as part of the consultation?NICE

Useful links and resources:


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