Ayurveda interventions for non-specific chronic low back pain- protocol for a systematic review and network meta-analysis

Introduction: Low back pain (570 million prevalent cases worldwide) is the main contributor to the overall burden of musculoskeletal conditions. The most common form of low back pain is non-specific low back pain (NSCLBP) (almost 90 %). There are no treatments that completely cure chronic low back pain. Ayurveda is one of the traditional systems of Indian medicine commonly practiced in Southeast Asian countries. Even though Ayurveda interventions (oral medication or procedure-based treatment or combined therapy) are practiced widely for this condition, there is ambiguity about the hierarchy of treatment. The present review has been planned to compare all the available Ayurveda treatment modalities for NSCLBP in terms of efficacy, and safety, in all the age groups of patients. Methods: This review will be written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the PRISMA extension for network meta-analyses. Electronic searches will be carried out in PubMed, Scopus, TRIP, Website of Indexing of Indian Medical Journals, the Cochrane Register for Controlled Trials, The Clinical Trials Registry- India, AYUSH research portal, and Digital Helpline for Ayurveda Research Articles, and other pre-print repositories since its inception till 31st March 2024. Randomized controlled trials, randomized cross-over studies, cluster-randomized studies, and nonrandomized studies of interventions (prospective cohort studies, non-randomized clinical trials) will be included. The risk of bias will be assessed with ROB-2, ROBINS-I, and other revised risk of bias tools for cross-over studies and cluster randomised studies recommended by the Cochrane collaboration. To evaluate the credibility of the findings, the Grading of Recommendations Assessment, Development, and Evaluation method for network meta-analysis will be implemented. A narrative approach to synthesize and report qualitative and quantitative data will be used, and where feasible, we will conduct network meta-analyses using STATA software. Conclusions: This protocol defines a plan of the study that would facilitate the process of recommending treatment for NSCLBP, by providing a treatment hierarchy of Ayurvedic treatment to the policymakers and stakeholders.