Low back pain is a severe global health problem. Evaluating the effects of interventions using rigorously designed and conducted randomised controlled trials is essential to optimise care. However, it is unclear which countries are undertaking trials in low back pain and if a country’s income level is related to the quality of these trials. A recent meta-epidemiological study was undertaken to compare the frequency and methodological quality of trials of physiotherapy interventions for low back pain conducted in countries with different income levels. Trials evaluating physiotherapy interventions for low back pain were retrieved from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au), Literatura Latino Americana em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO). Methodological quality was evaluated using the total PEDro score (range 0-10, higher scores indicate better quality), with the scores downloaded from PEDro. The authors extracted the country of the corresponding author’s institutional affiliation from the full-text article for each included trial. Gross National Income (GNI) per capita as reported by the World Bank on 1 July 2020 was used to classify countries into low-income (GNI < 1,036 USD), lower-middle-income (GNI 1,036 to 4,045 USD), upper-middle-income (GNI 4,046 to 12,535 USD), and high-income (GNI > 12,535 USD) categories. However, low- and lower-middle-income categories were merged the analyses due to the low prevalence of trials from low-income countries. A total of 2,552 trials were included in the analyses. The included trials were conducted in 65 countries, with the six most common countries being the United States (16%), China (9%), the United Kingdom (7%), Turkey (5%), Brazil (4%), and Germany (4%). 70% of trials were conducted in high-income countries, with 24% in upper-middle income and 6% in low- or lower-middle- income countries. The mean (standard deviation) total PEDro score was 4.8 (1.6) for trials conducted in low- or lower-middle-income countries, 5.4 (1.5) for trials conducted in upper-middle-income countries, and 5.5 (1.7) for trials conducted in high-income countries. Trials from low- or lower-middle-income countries had lower methodological quality than those from upper-middle- and high-income countries, but the mean difference was small (-0.6 points (95% confidence interval -0.9 to -0.3) and -0.7 (-1.1 to -0.5) respectively). There was no difference in the total PEDro score for trials conducted in upper-middle-income and high-income countries (-0.2; -0.3 to 0.0). The study concluded that most trials evaluating physiotherapy interventions for low back pain are conducted in countries with high-income economies and that country income level appears to have a small influence on the methodological quality of these trials. Implementing strategies to improve the methodological rigor of trials in people with low back pain is necessary in all countries, regardless of income level.

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