An Overview of Evidence From the World Health Organization Commissioned Systematic Reviews for Chronic Primary Low Back Pain

OBJECTIVE: In 2023, the World Health Organization (WHO) published the results of 20 systematic reviews assessing the effectiveness of non-surgical interventions for chronic LBP using similar methodologies. We aimed to (a) summarise the results of the reviews and (b) identify priorities for future research. DESIGN: Overview of the WHO-commissioned systematic reviews for chronic primary LBP. STUDY SELECTION CRITERIA: We collated the effects of interventions for chronic LBP on pain intensity or back-specific function at 3- or 12-months follow-up that were included in 20 WHO-commissioned systematic reviews for community-dwelling adults with chronic primary LBP. DATA SYNTHESIS: Pooled effect sizes with 95% confidence intervals, number of trials, sample size, and GRADE certainty of evidence were presented in summary forest plots by intervention, comparator, outcome (pain intensity, back-specific functional status), and time-point (short-term, long-term) or in tabular form. To inform priorities for future research we identified interventions with (i) high-certainty evidence to inform clinical practice and policy; (ii) promising effects but uncertain evidence to guide future research; and (iii) little evidence of effect where future research may not be indicated. RESULTS: We synthesised 93 comparisons (347 RCTs, 46,788 participants) across 17 intervention categories. There was high or moderate certainty evidence for two comparisons, both with trivial or small effect sizes. Interventions suggesting moderate or large effect sizes were supported by low or very-low certainty evidence. CONCLUSION: Despite the large volume of evidence, there were limited definitive conclusions to draw due to small effect sizes and low or very low certainty evidence.