Guía de práctica clínica para el diagnóstico y tratamiento de lumbalgia aguda y subaguda en el Seguro Social del Perú (EsSalud)

Abstract

El presente artículo resume la guía de práctica clínica para el diagnóstico y tratamiento de lumbalgia aguda y subaguda en el Seguro Social del Perú (EsSalud). Provee recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de lumbalgia aguda y subaguda en EsSalud. Para su elaboración se conformó un grupo local (GEG-Local) que incluyó médicos especialistas y metodólogos. El GEG-Local formuló 11 preguntas clínicas a ser respondidas por la presente guía. Se realizaron búsquedas sistemáticas de revisiones y estudios primarios en Pubmed, Embase y la biblioteca Cochrane durante el 2016. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La calidad de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). La guía aborda tres temas: diagnóstico (tres preguntas), tratamiento no farmacológico (cuatro preguntas) y tratamiento farmacológico de lumbalgia (cuatro preguntas). Se formularon 12 recomendaciones y 2 flujogramas. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de lumbalgia en EsSalud.

This article summarizes the clinical practice guide (CPG) for the diagnosis and management of acute and sub-acute low back pain in the Social Security of Peru (EsSalud). Objective. To provide clinical recommendations based on evidence for the diagnosis and management of acute and sub-acute low back pain in EsSalud. Methods. A CPG for the diagnosis and management of low-back pain in EsSalud was developed. To this end, a local guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 11 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in Pubmed, Embase and the Cochrane library during 2016. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations and the flowcharts of diagnosis and treatment. Finally, the CPG was approved with Resolution N 43-IETSI-ESSALUD-2016. Results. This CPG addressed 11 clinical questions, divided into three topics: diagnosis (three questions), non-pharmacological treatment (four questions), and pharmacological treatment of low-back pain (four questions). Based on these questions, 12 recommendations (2 strong recommendations and 10 conditional recommendations), and 2 flowcharts were formulated. Conclusion. This article summarizes the methodology and evidence-based conclusions from the CPG for the diagnosis and management of low-back pain in EsSalud.