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International comparative study of low back pain care pathways and analysis of key interventions

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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.

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Availability of data and material

All data are provided in the Supplementary Materials.

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Acknowledgments

We wish to thank dr. John Lee (London, UK), Dr. Charles Greenough (North East England, UK), Mrs. Susan Murphy (Waterford, Ireland), Mr. Andrew Bidos (Ontario, Canada), Mrs. Terry Blackmore (Sasketchewan, Canada), Dr. Ian Paskowski and James Berghelli (Plymouth, USA) and Dr. Susanne Schwarzkopf (Nuremberg, Germany) for their enthusiast help in providing insight into their low back pain pathways.

Funding

This Project was funded by the Belgian Healthcare Knowledge Center (KCE).

Author information

Authors and Affiliations

  1. Leuven Institute for Healthcare Policy, KULeuven, Leuven, Belgium

    Ellen Coeckelberghs & Kris Vanhaecht

  2. Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium

    Hilde Verbeke

  3. Belgian Health Care Knowledge Centre, Brussels, Belgium

    Anja Desomer & Pascale Jonckheer

  4. Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada

    Daryl Fourney

  5. Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

    Paul Willems

  6. Groningen Spine Center, University Medical Center Groningen, Groningen, The Netherlands

    Maarten Coppes

  7. Department of Surgery, Division of Orthopaedics, University Health Network Toronto, Toronto, Canada

    Raja Rampersaud

  8. Radboud University Medical Center, Nijmegen, The Netherlands

    Miranda van Hooff & Els van den Eede

  9. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Gerit Kulik

  10. Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Pierre de Goumoëns

  11. Neurosurgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium

    Bart Depreitere

Authors
  1. Ellen Coeckelberghs
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  2. Hilde Verbeke
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  4. Pascale Jonckheer
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  9. Miranda van Hooff
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  12. Pierre de Goumoëns
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  14. Bart Depreitere
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Correspondence to Bart Depreitere.

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Coeckelberghs, E., Verbeke, H., Desomer, A. et al. International comparative study of low back pain care pathways and analysis of key interventions. Eur Spine J 30, 1043–1052 (2021). https://doi.org/10.1007/s00586-020-06675-2

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