Development of a low back pain care pathway in an academic hospital system: results of a consensus process.
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2024-01
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Abstract
Background
Low back pain (LBP) is the leading cause of disability worldwide and a significant component of healthcare expenditures. Clinical practice guidelines (CPGs) have been highlighted as a key resource to improve the quality of care. This study aimed to develop a clinical pathway for LBP based on CPGs in an academic health system.Methods
We conducted a modified Delphi study of clinicians caring for patients with LBP who were asked to rate 21 CPG-informed seed statements through an online survey. The goal was to identify statements that achieved a minimum of 80% consensus among panelists.Results
Thirty-five healthcare providers participated as panelists. The majority of participants were male (68.6%), had MD or DO (62.9%) degrees, and were clinicians (73.8%) working in neurosurgery (36.1%), orthopedics (25.7%), emergency medicine (14.3%), or physical therapy (11.4%). Initially, consensus was reached on 20 of 21 seed statements. One statement did not reach consensus in the initial round and was revised into two separate statements based on feedback from panelists. One of these statements achieved consensus in the second review round. All statements reaching consensus were incorporated into a care pathway consisting of diagnosis, evaluation, and treatment for LBP.Conclusion
Healthcare providers across various disciplines supported statements interpreting current CPGs related to care for LBP. This study represents a step toward supporting guideline-concordant care for LBP. Additional research is needed to assess how such pathways impact actual clinical care.Type
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Bejarano, Geronimo, Robert Vining, Devan P Desai, Joe Minchew, H Michael Guo and Christine Goertz (2024). Development of a low back pain care pathway in an academic hospital system: results of a consensus process. Journal of orthopaedic surgery and research, 19(1). p. 11. 10.1186/s13018-023-04492-z Retrieved from https://hdl.handle.net/10161/33279.
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Joe Tommy Minchew
I see all conditions and disorders that affect the spine in young adults to older adults. We work very hard to go through their history along with a physical exam to try to determine the cause of their problems. We then look at the best treatments available to relieve their symptoms. I think it’s important for me to establish a relationship with my patient and to figure out what the most troubling aspect of their condition is for them. My favorite part of my job is helping people alleviate their spinal pain and doing it in the way that’s the most appropriate for them. I’m just as excited about a patient whose pain improves with medicine and physical therapy as I am about a patient who needs surgery.
Christine Goertz
Christine Goertz, D.C., Ph.D. is a Professor in Musculoskeletal Research at the Duke Clinical Research Institute and Vice Chair for Implementation of Spine Health Innovations in the Department of Orthopaedic Surgery at Duke University. She is also the Chief Executive Officer of the Spine Institute for Quality and an Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Formerly she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 30-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz has received nearly $44M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and co-authored over 130 peer-reviewed papers. Dr. Goertz has previously served as a Member of the Interagency Pain Research Coordinating Committee (IPRCC), the Bone and Joint Initiative Low Back Pain Task Force, the CDC Opioid Workgroup and Chairperson of the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI).
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