Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic has greatly limited the access of patients to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic lockdown. In most low- and middle-income countries, as well as many underserved marginalized communities in high income countries there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. OBJECTIVE To describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. METHODS One set of guides for patients and one for clinicians were developed by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on four continents participated. They included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga as well as epidemiologists, research methodologists, and lay stakeholders. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. RESULTS The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care; when to contact a clinician, or when to seek emergency care. The Clinician Guide is a 5-step process. 1. Obtain and document patient demographics, location of primary clinical symptoms and psychosocial information. 2. Review the symptoms noted in the patient guide. 3. Determine of the GSCI classification of the patient’s spine related complaints. 4. Ask additional questions to determine the GSCI subclassification of the symptom pattern. 5. Consider appropriate treatment interventions. CONCLUSIONS The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine related symptoms or disorders including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government mandated physical or social distancing due to infections such as the COVID pandemic. They should also be of value in underserved communities in high, middle, and low-income countries where there is a dearth of accessible trained spine care clinicians, These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Global research hotspots and trends in the field of spine surgery during the COVID-19 pandemic: A bibliometric and visual analysis

“…However, owing to the great demands of the field, spine surgeons have been more concerned about the timing of surgery, perioperative care, treatment standards, and quality of life of the patients undergoing spine surgery. Additionally, the social isolation and strict lockdowns implemented to curb the disease spread resulted in delays in the detection and treatment of spinal disorders (28,29).…”