Ellen Coeckelberghs1, Hilde Verbeke2, Anja Desomer3, Pascale Jonckheer3, Daryl Fourney4, Paul Willems5, Maarten Coppes6, Raja Rampersaud7, Miranda van Hooff8, Els van den Eede8, Gerit Kulik9, Pierre de Goumoëns10, Kris Vanhaecht1, Bart Depreitere11. 1. Leuven Institute for Healthcare Policy, KULeuven, Leuven, Belgium. 2. Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium. 3. Belgian Health Care Knowledge Centre, Brussels, Belgium. 4. Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada. 5. Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Groningen Spine Center, University Medical Center Groningen, Groningen, The Netherlands. 7. Department of Surgery, Division of Orthopaedics, University Health Network Toronto, Toronto, Canada. 8. Radboud University Medical Center, Nijmegen, The Netherlands. 9. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 10. Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 11. Neurosurgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium. bart.depreitere@uzleuven.be.
Abstract
PURPOSE: Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. METHODS: International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. RESULTS: Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. CONCLUSION: Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
PURPOSE:Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. METHODS: International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. RESULTS: Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. CONCLUSION: Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
Entities:
Keywords:
Care pathway; Hospital care; Low back pain; Multidisciplinary work; Patient reported outcome measures; Primary care; Radicular pain; Triage
Authors: Pierre de Goumoens; Stéphane Genevay; Enrico Tessitore; Maroun Zaarour; John Michael Duff; Antonio Faundez; Constantin Schizas; Maximilian Schindler; Davide Zoccatelli; Antonio Foletti; Iohn Norberg; Liliana Belgrand; Anne-Claude Griesser; Gerit Kulik Journal: Rev Med Suisse Date: 2014-04-30
Authors: Donald R Murphy; Brian Justice; Christopher G Bise; Michael Timko; Joel M Stevans; Michael J Schneider Journal: Chiropr Man Therap Date: 2022-02-09