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 and Vice Chair for Implementation of Spine Health Innovations in the Department of Orthopaedic Surgery at Duke University School of Medicine. She spearheaded the development and implementation of the Duke Spine Health Program and leads interdisciplinary teams to design and implement clinical research studies that increase understanding of the effectiveness of patient-centered, non-drug treatments for spine-related disorders. Dr. Goertz has co-authored more than 150 scientific papers, and her work has been cited more than 7000 thousand times. She has received nearly $45M in federal funding as a principal investigator and was ranked in the top 10 for NIH funding among investigators in the Medical School Department of Orthopedics by the Blue Ridge Institute for Medical Research in 2022, 2023, and 2024. Dr. Goertz has previously served as a Member of the Interagency Pain Research Coordinating Committee, the Centers for Disease Control and Prevention’s Opioid Working Group, and as Chairperson of the Board of Governors for the Patient Centered Outcomes Research Institute. She is also the author of the book Take Your Back Back: Whole Health Healing for Low Back Pain, which Simon and Schuster will release on October 6, 2026. Dr. Goertz received her Doctor of Chiropractic 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.
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