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. 2015;86(5):523-33.
doi: 10.3109/17453674.2015.1036696.

A proposed set of metrics for standardized outcome reporting in the management of low back pain

R Carter Clement  1 , Adina Welander  2 , Caleb Stowell  3 , Thomas D Cha  4 , John L Chen  5 , Michelle Davies  6 , Jeremy C Fairbank  7 , Kevin T Foley  8 , Martin Gehrchen  9 , Olle Hagg  10 , Wilco C Jacobs  11 , Richard Kahler  12 , Safdar N Khan  13 , Isador H Lieberman  14 , Beth Morisson  15 , Donna D Ohnmeiss  14 , Wilco C Peul  16 , Neal H Shonnard  17 , Matthew W Smuck  18 , Tore K Solberg  19   20 , Bjorn H Stromqvist  21 , Miranda L Van Hooff  22 , Ajay D Wasan  23 , Paul C Willems  24 , William Yeo  25 , Peter Fritzell  26   27
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A proposed set of metrics for standardized outcome reporting in the management of low back pain

R Carter Clement et al. Acta Orthop. 2015.

Abstract

Background and purpose: Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set.

Patients and methods: An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions.

Results: Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools.

Interpretation: The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.

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Figures

Figure 1.
Figure 1.
A. A tool for recording the date and type of prior treatment. B. A tool for recording interventions performed on an ongoing basis.
Figure 2.
Figure 2.
The recommended timeline for collection of each outcome measure.
Figure 3.
Figure 3.
A classification scheme to define interventions as either index events or reoperations.
See this image and copyright information in PMC

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References

    1. Andersson G. The Adult Spine; Principles and Practice, Frymoyer JW. Philadelphia, PA: Lippincott-Raven Publishers; 1997. The Epidemiology of Spinal Disorders; pp. pp: 93–141.
    1. Axon RN, Williams MV. Hospital readmission as an accountability measure. JAMA. 2011;305(5):504–5. - PubMed
    1. Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life hea.... Health Qual Life Outcomes. 2005;3:51. - PMC - PubMed
    1. Bergner M, Bobbitt RA, Pollard WE, Martin DP, Gilson BS. The sickness impact profile: validation of a health status measure. Med Care. 1976;14(1):57–67. - PubMed
    1. Bo M, Cacello E, Ghiggia F, Corsinovi L, Bosco F. Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr. 2007;44(3):215–24. - PubMed