Poster Presentation Sydney Spinal Symposium 2025

Are clinician characteristics associated with the effectiveness of interventions for the management of low back pain: a systematic review and meta-analysis (#21)

Stephen Sharp 1 , Hazel Jenkins 2 , Natasha Pocovi 1 , Laura Montgomery 3 , Mark Hancock 1
  1. Department of Health Sciences, Macquarie University, NSW, Australia
  2. Department of Chiropractic, Macquarie University, NSW, Australia
  3. Faculty of Medicine and Health, School of Health Sciences, Sydney University, Camperdown, NSW, Australia

Introduction:

Treatments for low back pain (LBP) typically produce small to moderate effects. As LBP is a complex, multifactorial biopsychosocial condition (1, 2), it seems likely that clinician skill or competence may impact intervention effectiveness.  Delivering effective biopsychosocial care requires a combined skill set that is often challenging for clinicians to deliver well (3, 4). Equally, in biomedical interventions like surgery, it is also likely that clinician skill may impact effectiveness. However, it remains unclear whether clinician characteristics (e.g. knowledge, experience, skill or competency) influence the effects of interventions. A better understanding of how existing trial results are influenced by clinician characteristics is needed.

Purpose/Aim:

To assess if clinician characteristics are associated with the effectiveness of interventions for the management of LBP.

Methods:

This systematic review was registered on PROSPERO (CRD42025634050) and reported according to PRISMA-2020 guidelines. MEDLINE, Embase and CINAHL were searched from inception to January 2025. Randomised/non-randomised controlled trials or cohort studies investigating associations between clinician characteristic and patient health outcomes for any LBP interventions were included. Measures of association (e.g., odds ratio, risk ratio, standardised mean difference with 95% CIs) were extracted.  Risk of bias was assessed using Cochrane Risk of Bias 2 and certainty of evidence was assessed using the GRADE approach.

Results:

Of 6020 identified studies, 172 were reviewed by full text, with 58 meeting inclusion criteria. Of these, 48 investigated surgical and 10 investigated conservative interventions. Common clinician characteristics investigated were years of experience, training level, and specialty. Data analysis is ongoing, and results will be presented at the symposium.

Conclusion:

This will be the first systematic review to assess whether clinician characteristics are associated with the effectiveness of LBP interventions. If such characteristics affect treatment outcomes, this is important for interpreting trial results and guiding future research.

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