SUMMARIES OF JUDGEMENTS ACROSS ETD DOMAINS

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WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings [Internet]. Geneva: World Health Organization; 2023.

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WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings [Internet].

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ANNEX 3SUMMARIES OF JUDGEMENTS ACROSS ETD DOMAINS

This Annex provides a summary of judgements made by the GDG for each EtD domain, by intervention. The tables reflect judgements made by all GDG members, while the rationale text for each intervention summarises the majority judgements.

Table C1Summary of judgements for structured and standardized education and/or advice (intervention A.1)

EtD domain	All adults	Older people
Benefits	Small; trivial	Uncertain
Harms	Trivial; uncertain	Uncertain
Balance benefits to harms	Probably favours standardized education and/or advice	Probably favours standardized education and/or advice
Overall certainty	Very low	Very low
Values and preferences	Possibly important uncertainty or variability; no important uncertainty or variability	Possibly important uncertainty or variability; no important uncertainty or variability
Resource considerations	Moderate costs; varies	Moderate costs; varies
Equity and human rights	Probably increased	Probably increased
Acceptability	Yes	Yes
Feasibility	Yes; probably yes	Yes; probably yes

Table C2Summary of judgements for structured exercise therapies or programmes (intervention B.1)

EtD domain	All adults	Older people
Benefits	Small; moderate; trivial; uncertain	Small; moderate
Harms	Trivial; uncertain	Uncertain
Balance benefits to harms	Favours exercise; probably favours exercise; uncertain	Probably favours exercise; uncertain
Overall certainty	Low; very low	Very low
Values and preferences	Possibly important uncertainty or variability; no important uncertainty or variability	Possibly important uncertainty or variability; no important uncertainty or variability
Resource considerations	Moderate costs; negligible costs and savings; varies (according to country and health system)	Moderate costs; negligible costs and savings; varies (according to country and health system)
Equity and human rights	Probably increased; probably reduced; no impact; varies	Probably increased; probably reduced; no impact; varies
Acceptability	Yes; probably yes; uncertain; varies	Probably yes; uncertain; varies
Feasibility	Yes	Yes

Table C3Summary of judgements for needling therapies (intervention B.2)

EtD domain	All adults	Older people
Benefits	Small; uncertain	Small; trivial; uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Probably favours needling therapies; probably does not favour needling therapies; uncertain	Probably favours needling therapies; probably does not favour needling therapies; uncertain
Overall certainty	Low; very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Large costs; moderate costs; varies	Large costs, moderate costs; varies
Equity and human rights	Probably reduced; uncertain	Probably reduced; uncertain
Acceptability	Probably yes; varies	Probably yes; varies
Feasibility	Uncertain; varies	Uncertain; varies

Table C4Summary of judgements for spinal manipulative therapy (SMT) (intervention B.3)

EtD domain	All adults	Older people
Benefits	Moderate; small; trivial; uncertain; varies	Moderate; small; trivial; uncertain
Harms	Small; trivial; uncertain	Small; trivial; uncertain
Balance benefits to harms	Probably favours SMT; probably does not favour SMT; uncertain	Probably favours SMT; probably does not favour SMT; uncertain
Overall certainty	Very low; low	Very low
Values and preferences	Probably important uncertainty or variability; possibly important uncertainty or variability	Probably important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate costs; varies	Moderate costs; varies
Equity and human rights	No impact; probably reduced (traction especially); uncertain; varies	No impact; probably reduced (traction especially); uncertain; varies
Acceptability	Yes; probably yes; probably no; uncertain; varies	Yes; probably yes; probably no; uncertain; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C5Summary of judgements for massage (intervention B.4)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain; varies	Small; trivial; uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Probably favours massage; probably does not favour massage; uncertain	Probably favours massage; probably does not favour massage; uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	Probably important uncertainty or variability; possibly important uncertainty or variability	Probably important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate costs; uncertain; varies	Moderate costs; varies
Equity and human rights	No impact; probably reduced (traction especially); varies	No impact; probably reduced (traction especially); uncertain; varies
Acceptability	Yes; probably yes; probably no; uncertain; varies	Yes; probably yes; probably no; uncertain; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C6Summary of judgements for traction (intervention B.5)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Small; trivial; uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Probably does not favour traction; uncertain	Probably does not favour traction; uncertain
Overall certainty	Very low	Very low
Values and preferences	Probably important uncertainty or variability; possibly important uncertainty or variability	Probably important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate costs; varies	Moderate costs; varies
Equity and human rights	Probably reduced; uncertain; varies	Probably reduced; uncertain; varies
Acceptability	Yes; probably yes; probably no; uncertain; varies	Yes; probably yes; probably no; uncertain; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C7Summary of judgements for therapeutic ultrasound (intervention B.6)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Small; trivial; uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Does not favour ultrasound; probably does not favour ultrasound; uncertain	Does not favour ultrasound; probably does not favour ultrasound; uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	Possibly important uncertainty or variability; probably no important uncertainty or variability	Possibly important uncertainty or variability; probably no important uncertainty or variability
Resource considerations	Moderate; moderate costs; negligible; negligible costs and savings	Moderate; moderate costs; negligible; negligible costs and savings
Equity and human rights	No impact; probably reduced; uncertain	No impact; probably reduced; uncertain
Acceptability	Yes; probably yes; probably no; varies	Yes; probably yes; probably no; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C8Summary of judgements for transcutaneous electrical nerve stimulation (intervention B.7)

EtD domain	All adults	Older people
Benefits	Small; uncertain	Small; uncertain
Harms	Small; uncertain	Small; uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate costs; high costs; varies (according to country and health system)	Moderate costs; high costs; varies (according to country and health system)
Equity and human rights	No impact; probably reduced; varies	No impact; probably reduced; varies
Acceptability	Probably yes; uncertain; varies	Probably yes; uncertain; varies
Feasibility	Probably yes	Probably yes

Table C9Summary of judgements for assistive products: lumbar braces, belts and/or supports (intervention B.8.1)

EtD domain	All adults	Older people
Benefits	Moderate; trivial; uncertain: no evidence	Trivial; uncertain: no evidence
Harms	Moderate; trivial; uncertain: no evidence	Moderate; uncertain: no evidence
Balance benefits to harms	Probably favours lumbar braces, belts and/or supports; probably does not favour lumbar braces, belts and/or supports; uncertain: no evidence	Probably favours lumbar braces, belts and/or supports; probably does not favour lumbar braces, belts and/or supports; uncertain: no evidence
Overall certainty	Very low: no evidence	Very low: no evidence
Values and preferences	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty; no important uncertainty or variability	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty; no important uncertainty or variability
Resource considerations	Moderate; moderate costs; negligible; varies	Moderate; moderate costs; negligible; varies
Equity and human rights	No impact; reduced; uncertain	No impact; reduced; uncertain
Acceptability	Yes, probably yes; probably no	Yes; probably yes; probably no
Feasibility	Yes; probably yes; uncertain	Yes; probably yes; uncertain

Table C10Summary of judgements for operant therapy (intervention C.1)

EtD domain	All adults	Older people
Benefits	Moderate; uncertain	Moderate; uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Probably favours operant therapy; uncertain	Probably favours operant therapy; uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate; large; varies	Moderate; large; varies
Equity and human rights	Possibly reduced; no impact; uncertain; varies	Possibly reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; varies	Probably yes; probably no; varies
Feasibility	Varies	Varies

Table C11Summary of judgements for respondent therapy (intervention C.2)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Uncertain
Harms	Trivial; uncertain	Uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate; large; varies	Moderate; large; varies
Equity and human rights	Possibly reduced; no impact; uncertain; varies	Possibly reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; varies	Probably yes; probably no; varies
Feasibility	Varies	Varies

Table C12Summary of judgements for cognitive therapy (intervention C.3)

EtD domain	All adults	Older people
Benefits	Trivial; uncertain	Uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate; large; varies	Moderate; large; varies
Equity and human rights	Possibly reduced; no impact; uncertain; varies	Possibly reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; varies	Probably yes; probably no; varies
Feasibility	Varies	Varies

Table C13Summary of judgements for cognitive behavioural therapy (intervention C.4)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Small; trivial; uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Probably favours cognitive behavioural therapy; uncertain	Probably favours cognitive behavioural therapy; uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate; large; varies	Moderate; large; varies
Equity and human rights	Possibly reduced; no impact; uncertain; varies	Possibly reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; varies	Probably yes; probably no; varies
Feasibility	Varies	Varies

Table C14Summary of judgements for mindfulness-based stress reduction therapy (intervention C.5)

EtD domain	All adults	Older people
Benefits	Uncertain	Uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Moderate; large; varies	Moderate; large; varies
Equity and human rights	Possibly reduced; no impact; uncertain; varies	Possibly reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; varies	Probably yes; probably no; varies
Feasibility	Varies	Varies

Table C15Summary of judgements for opioid analgesics (intervention D.1.1)

EtD domain	All adults	Older people
Benefits	Small; moderate	Small; moderate
Harms	Small; moderate; large	Small; moderate; large
Balance benefits to harms	Probably favours opioid analgesics; probably does not favour opioid analgesics; does not favour opioid analgesics	Probably favours opioid analgesics; probably does not favour opioid analgesics; does not favour opioid analgesics
Overall certainty	Moderate	Moderate
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C16Summary of judgements for non-steroidal anti-inflammatory drugs (NSAIDs) (intervention D.1.2)

EtD domain	All adults	Older people
Benefits	Small; moderate	Small; moderate
Harms	Small; moderate	Small; moderate
Balance benefits to harms	Favours NSAIDs; probably favours NSAIDs	Favours NSAIDs; probably favours NSAIDs
Overall certainty	Moderate	Moderate
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C17Summary of judgements for serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressants (intervention D.1.3)

EtD domain	All adults	Older people
Benefits	Small; trivial	Small; trivial
Harms	Small; moderate	Small; moderate
Balance benefits to harms	Probably favours SNRI antidepressants; probably does not favour SNRI antidepressants	Probably favours SNRI antidepressants; probably does not favour SNRI antidepressants
Overall certainty	Low	Low
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C18Summary of judgements for tricyclic antidepressants (intervention D.1.4)

EtD domain	All adults	Older people
Benefits	Trivial; uncertain	Trivial; uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Probably does not favour tricyclic antidepressants; does not favour tricyclic antidepressants	Probably does not favour tricyclic antidepressants; does not favour tricyclic antidepressants
Overall certainty	Very low	Very low
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C19Summary of judgements for anticonvulsants (intervention D.1.5)

EtD domain	All adults	Older people
Benefits	Trivial; uncertain; small	Trivial; uncertain
Harms	Uncertain; moderate	Uncertain; moderate
Balance benefits to harms	Does not favour anticonvulsants	Does not favour anticonvulsants
Overall certainty	Very low	Very low
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C20Summary of judgements for skeletal muscle relaxants (intervention D.1.6)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Small; trivial; uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C21Summary of judgements for glucocorticoids (intervention D.1.7)

EtD domain	All adults	Older people
Benefits	Uncertain	Uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Does not favour glucocorticoids; uncertain	Does not favour glucocorticoids; uncertain
Overall certainty	Very low	Very low
Values and preferences	No important uncertainty or variability; varies	No important uncertainty or variability; varies
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	No impact; probably reduced	No impact; probably reduced
Acceptability	Yes; probably no	Yes; probably no
Feasibility	Yes	Yes

Table C22Summary of judgements for injectable local anaesthetics (intervention D.3)

EtD domain	All adults	Older people
Benefits	Trivial; uncertain	Trivial; uncertain
Harms	Trivial; uncertain	Trivial; uncertain
Balance benefits to harms	Probably does not favour injectable local anaesthestics; uncertain	Probably does not favour injectable local anaesthestics; uncertain
Overall certainty	Very low	Very low
Values and preferences	Important uncertainty or variability; possibly important uncertainty or variability	Important uncertainty or variability; possibly important uncertainty or variability
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	Probably reduced; reduced; no impact; uncertain; varies	Probably reduced; reduced; no impact; uncertain; varies
Acceptability	Probably yes; probably no; uncertain; varies	Probably yes; probably no; uncertain; varies
Feasibility	Yes; probably yes	Yes; probably yes

Table C23Summary of judgements for topical Cayenne pepper [Capsicum frutescens] (intervention D.4.1)

EtD domain	All adults	Older people
Benefits	Moderate; small; uncertain	Moderate; small; uncertain
Harms	Moderate; small; uncertain	Moderate; small; uncertain
Balance benefits to harms	Probably favours topical Cayenne pepper; probably does not favour topical Cayenne pepper; neutral; uncertain	Probably favours topical Cayenne pepper; probably does not favour topical Cayenne pepper; neutral; uncertain
Overall certainty	Low	Low
Values and preferences	Possibly important uncertainty or variability; probably no important uncertainty or variability	Possibly important uncertainty or variability; probably no important uncertainty or variability
Resource considerations	Moderate costs; varies	Moderate costs; varies
Equity and human rights	No impact; uncertain; varies	No impact; uncertain; varies
Acceptability	Yes; varies	Yes; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C24Summary of judgements for Devil’s claw [Harpagophytum procumbens] (intervention D.4.2)

EtD domain	All adults	Older people
Benefits	Small; trivial; uncertain	Small; trivial; uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Probably does not favour Devil’s claw; uncertain	Probably does not favour Devil’s claw; uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	Possibly important uncertainty or variability; probably no important uncertainty or variability	Possibly important uncertainty or variability; probably no important uncertainty or variability
Resource considerations	Moderate; varies	Moderate; varies
Equity and human rights	No impact; uncertain; varies	No impact; uncertain; varies
Acceptability	Yes; varies	Yes; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C25Summary of judgements for white willow [Salix spp.] (intervention D.4.3)

EtD domain	All adults	Older people
Benefits	Uncertain	Uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Low; very low	Low; very low
Values and preferences	Possibly important uncertainty or variability; probably no important uncertainty or variability	Possibly important uncertainty or variability; probably no important uncertainty or variability
Resource considerations	Moderate; varies	Moderate; varies
Equity and human rights	No impact; uncertain; varies	No impact; uncertain; varies
Acceptability	Yes; varies	Yes; varies
Feasibility	Yes; probably yes; varies	Yes; probably yes; varies

Table C26Summary of judgements for pharmacological weight loss (intervention E.1.1)

EtD domain	All adults	Older people
Benefits	Uncertain	Uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Uncertain; probably does not favour pharmacological weight loss	Uncertain; probably does not favour pharmacological weight loss
Overall certainty	Very low	Very low
Values and preferences	Probably important uncertainty or variability	Probably important uncertainty or variability
Resource considerations	Moderate costs; varies (according to country and health system)	Moderate costs; varies (according to country and health system)
Equity and human rights	Possibly increased; uncertain; possibly reduced (especially related to stigma)	Possibly increased; uncertain; possibly reduced (especially related to stigma)
Acceptability	Yes, probably yes (among health workers); uncertain for people with CPLBP	Yes, probably yes (among health workers); uncertain for people with CPLBP
Feasibility	Probably yes, probably no, uncertain, varies	Probably yes, probably no, uncertain, varies

Table C27Summary of judgements for non-pharmacological weight loss (intervention E.1.2)

EtD domain	All adults	Older people
Benefits	Uncertain	Uncertain
Harms	Uncertain	Uncertain
Balance benefits to harms	Uncertain	Uncertain
Overall certainty	Very low	Very low
Values and preferences	Probably important uncertainty or variability	Probably important uncertainty or variability
Resource considerations	Moderate costs; varies (according to country and health system)	Moderate costs; varies (according to country and health system)
Equity and human rights	Possibly increased; uncertain; possibly reduced (especially related to stigma)	Possibly increased; uncertain; possibly reduced (especially related to stigma)
Acceptability	Yes, probably yes (among health workers); uncertain for people with CPLBP	Yes, probably yes (among health workers); uncertain for people with CPLBP
Feasibility	Probably yes, probably no, uncertain, varies	Probably yes, probably no, uncertain, varies

Table C28Summary of judgements for multicomponent biopsychosocial care (intervention E.2)

EtD domain	Care delivered by a single provider		Care delivered by a multi-disciplinary team (MDT)
EtD domain	All adults	Older people	All adults	Older people
Benefits	Small; uncertain	Small; uncertain	Moderate; small; uncertain	Small; uncertain
Harms	Uncertain	Uncertain	Uncertain	Uncertain
Balance benefits to harms	Probably favours multicomponent biopsychosocial care (single provider); uncertain	Probably favours multicomponent biopsychosocial care (single provider); uncertain	Probably favours multicomponent biopsychosocial care (MDT^* provider); uncertain	Probably favours multicomponent biopsychosocial care (MDT provider); uncertain
Overall certainty	Very low	Very low	Low; very low	Low; very low
Values and preferences	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty	Important uncertainty; possibly important uncertainty or variability; probably no important uncertainty
Resource considerations	Large costs; moderate costs; varies	Large costs; moderate costs; varies	Large costs; moderate costs; varies	Large costs; moderate costs; varies
Equity and human rights	Increased; probably increased; probably reduced; reduced; varies	Increased; probably increased; probably reduced; reduced; varies	Increased; probably increased; probably reduced; reduced; varies	Increased, probably increased; probably reduced; reduced; varies
Acceptability	Yes; probably yes; varies	Yes; probably yes; varies	Yes; probably yes; varies	Yes; probably yes; varies
Feasibility	Yes; probably yes; probably no; varies	Yes; probably yes; probably no; varies	Yes; probably yes; probably no; varies	Yes; probably yes; probably no; varies

*: MDT = multidisciplinary team

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