Adviceline: consultation exercise on low back pain

In May, we submitted the CSP’s response to the National Institute for Health and Care Excellence (NICE) consultation on non-specific low back pain. This is a hugely important guideline for physiotherapy, and members were asked to help inform the CSP’s response. We received a range of opinions, which we attempted to convey in an objective and constructive way. The full details of the response can be found online but below is a summary of what we said, why we said it, and what happens now.

Our first key point was to question the focus in the NICE consultation on group exercise rather than an individual approach. Many members welcomed the inclusion of exercise, but expressed concerns over the focus on group exercise. This, they noted, does not seem in line with the evidence reviewed by the guideline development group (GDG). As a result, we suggested that the recommendation is re-worded to take the focus away from group exercise, and for delivery approach to reflect the needs of the individual.

The next key points raise questions on how the evidence for acupuncture was reviewed. Many members were disappointed that acupuncture was a ‘do not use’ recommendation, and we aimed to articulate this in relation to what the evidence says.

We queried the rationale behind the requirements for superiority of acupuncture over ‘sham’. This requirement was not routinely applied to all interventions, and is potentially misaligned with the review question itself. What appeared to be an inequitable approach to the evidence for acupuncture in comparison to that taken with other modalities was also raised? 

As a next step, the GDG will review all comments received. When the final guideline is published in September, all consultation comments will be published alongside NICE’s response to them. 

Thanks to all members who took the time to respond to the consultation. Your contribution is greatly appreciated.

• Carley King is a CSP professional adviser

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