Background: A full update of a guideline is very resource intensive, thus often only partial updates are conducted. This can lead to inconsistencies in content and methods within the guideline.
Objectives: We aimed to analyse the feasibility of the full update strategy for the National Disease Management Guideline (NDMG) Low Back Pain.
Methods: Systematic reviews (SR) on the diagnosis and treatment of low back pain were systematically searched in Medline and Cochrane. Identified SR were assessed with AMSTAR and allocated to the recommendations. Recommendations, which needed further discussion, were directly referred to working groups. For all others, recommendations and new evidence was presented to the guideline developing group using an electronic survey tool to find a consensus. Non-consented recommendations were referred to working groups. Working groups discussed evidence and recommendations, which were subsequently formally consented in the guideline developing group.
Results: The systematic search identified 648 SR, 172 SR were included and allocated to recommendations. The guideline consists of 90 formally consented recommendations, 37 were referred directly to the working groups; 53 were presented using the electronic survey-tool and 28 of those were consented in the first round. Response rates ranged between 86% and 100%. Working groups needed 10 telephone conferences and 2 face-to-face meetings to discuss evidence for the 65 recommendations. Afterwards recommendations were formally consented. It took 18 months from initiating the update to the publication for external review. This was comparable to the update of the NDMG Diabetic Retinopathy (19 months, 32 recommendations) or the update of the chapter 'diagnosis' of the NDMG Coronary Heart Disease (19 months, 25 recommendations).
Conclusions: The strategy was very useful for updating the NDMG low back pain. The transparent electronic presentation of new evidence for existing recommendations saved time by filtering those recommendations that are still adequate and congruent with new evidence. The amount of time was comparable to the update of a major chapter of a NDMG.