Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.

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“…Improvement of low back and neck pain in this feasibility study showed to be comparable to findings in other studies [12,30,33,34].…”

Section: Main Clinical Findingssupporting

confidence: 90%

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

et al. 2010

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“…For example, Vos et al [11] found that while 97% of patients with a new episode of neck pain received advice, 18% were advised to rest. In Australia, referrals for imaging as identified in this and other studies [2,27] were much higher than those previously reported for patients with new neck pain (9% [11]) and new LBP (2-18% [24,26]). These findings suggest an overutilization of imaging by GPs in Australia, especially in light of the low prevalence (\1%) of serious spinal pathology (fracture, tumour) [28] and of the fact that routine imaging has been shown to not have a beneficial influence on clinical outcomes [29].…”

Section: Discussionmentioning

confidence: 52%

Ten-year survey reveals differences in GP management of neck and back pain

et al. 2012

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Purpose Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner's (GP) care is similar. While GP's management of LBP is well documented, little is known about GP's management of neck pain. We aimed to describe GP's management of new neck pain and compare this to GP's management of new LBP in Australia between April 2000 and March 2010. Methods All GP-patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations. Results General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP-patient encounters, respectively. GP's primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests. Conclusions This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.

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“…Seventeen studies used a minimum level of pain or 'symptoms' as a proxy for recovery; however, no two studies did so in exactly the same way (Table 1). Three recovery measures required the complete absence of pain, whereas three others fixed a cut-off score on the instrument [39,40,60,66] that categorised subjects with minimal pain levels as recovered. The remaining studies gave a description of the symptomatic state necessary to indicate recovery.…”

Section: Data Extractionmentioning

confidence: 99%

How is recovery from low back pain measured? A systematic review of the literature

et al. 2010

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Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care

Cited by 152 publications

References 23 publications

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Ten-year survey reveals differences in GP management of neck and back pain

How is recovery from low back pain measured? A systematic review of the literature

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