Conclusion
2 Is there a reasonable explanation as to how the intervention is likely to achieve the desired result and is there a body of research to support that theory?
3 What are the expected benefits of this intervention and how certain is it that I will experience these benefits?
4 What are the potential or known safety issues associated with this intervention and what is the likelihood that I may experience a harmful effect?
5 What is this intervention likely to cost and how does its cost compare to other available alternatives?
Basic Assumptions
1 The most conservative interventions are generally preferred as the starting point when seeking care for low back pain.
2 It may be necessary to gradually progress from more conservative to less conservative interventions if prior approaches have failed to produce the intended results and patients are appropriate candidates for those interventions.
3 Most clinicians and patients will prefer interventions with a clearly understood mechanism of action, strong evidence supporting their efficacy, a low incidence of reported harms, and favorable cost effectiveness.
4 When two or more interventions are similar with respect to theory, efficacy, safety, and costs, issues such as convenience, availability, and personal preference may also guide decision making.
5 Not all patients will respond to interventions in a similar manner, and a certain degree of trial and error is unavoidable when selecting interventions for low back pain.
6 All interventions for low back pain generally have diminishing returns, and persistent, severe low back pain is the least likely to completely resolve.
7 Patients and clinicians should focus more on physical function and activities of daily living rather than pain severity alone when monitoring progress.
8 Many factors (whether known, suspected, or unknown), contribute to the chronicity and disability that can be associated with low back pain.
9 A multidisciplinary management approach addressing biopsychosocial and pathoanatomic factors may be necessary when single interventions are unable to improve symptoms, physical function, and overall health.
Evidence of Efficacy
The first and probably the most important thing to determine before a treatment is selected is whether that treatment is likely to be of any benefit in relieving symptoms and improving function. As noted in Chapter 1, there are a number of criteria that can be used to assess the strength and quality of the scientific evidence supporting the efficacy of a specific intervention. If one understands these criteria, it is possible to list and compare the best available evidence supporting the efficacy of the different interventions. To facilitate this process, a framework such as the hierarchy of evidence may be used to interpret findings from different study designs.