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

R Carter Clement¹, Adina Welander², Caleb Stowell³, Thomas D Cha⁴, John L Chen⁵, Michelle Davies⁶, Jeremy C Fairbank⁷, Kevin T Foley⁸, Martin Gehrchen⁹, Olle Hagg¹⁰, Wilco C Jacobs¹¹, Richard Kahler¹², Safdar N Khan¹³, Isador H Lieberman¹⁴, Beth Morisson¹⁵, Donna D Ohnmeiss¹⁴, Wilco C Peul¹⁶, Neal H Shonnard¹⁷, Matthew W Smuck¹⁸, Tore K Solberg^{19

20}, Bjorn H Stromqvist²¹, Miranda L Van Hooff²², Ajay D Wasan²³, Paul C Willems²⁴, William Yeo²⁵, Peter Fritzell^{26

27}

Affiliations

¹ a 1 Department of Orthopaedic Surgery, University of North Carolina Hospitals , Chapel Hill, NC, USA.
² b 2 Boston Consulting Group , Stockholm, Sweden.
³ c 3 International Consortium for Health Outcomes Measurement , Boston, MA, USA.
⁴ d 4 Department of Orthopaedics, Massachusetts General Hospital , Boston, MA, USA.
⁵ e 5 Department of Orthopaedic Surgery , Singapore General Hospital, Singapore.
⁶ f 6 Patient representative , Brisbane, Australia.
⁷ g 7 Nuffield Orthopaedic Centre, University of Oxford , Oxford, UK.
⁸ h 8 Department of Neurosurgery, University of Tennessee Health Science Center , Memphis, TN, USA.
⁹ i 9 Department of Orthopaedic Surgery, Spine Section, Rigshospitalet, University Hospital of Copenhagen , Copenhagen, Denmark.
¹⁰ j 10 Spine Center Göteborg , Gothenburg, Sweden.
¹¹ k 11 Department of Neurosurgery, Leiden University Medical Center , Leiden, the Netherlands.
¹² l 12 BrizBrain and Spine , Brisbane, Australia.
¹³ m 13 Department of Orthopaedics, Division of Spine, Ohio State University , Wexner Medical Center, Columbus, OH, USA.
¹⁴ n 14 Texas Back Institute , Plano, TX, USA.
¹⁵ o 15 Newro Foundation , Brisbane, Australia.
¹⁶ p 16 Department of Neurosurgery, Leiden University Medical Center and Medical Center Haaglanden , Leiden and The Hague, the Netherlands.
¹⁷ q 17 Director, Spine SCOAP Collaborative, Rainier Orthopedic Institute , Puyallup, WA, US.
¹⁸ r 18 Department of Orthopaedic Surgery, PM&R Section, Stanford University , Palo Alto, CA, USA.
¹⁹ s 19 Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway , Tromsø, Norway.
²⁰ t 20 The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority , Tromsø, Norway.
²¹ u 21 Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital , Lund, Sweden.
²² v 22 Sint Maartenskliniek, Research , Nijmegen, the Netherlands.
²³ w 23 Department of Anesthesiology , University of Pittsburgh Medical Center Pittsburgh, PA, USA.
²⁴ x 24 Maastricht University Medical Center , Maastricht, the Netherlands.
²⁵ y 25 Orthopaedic Diagnostic Centre , Singapore General Hospital, Singapore.
²⁶ z 26 Department of Orthopaedic Surgery, Ryhov Hospital , Jönköping, Sweden.
²⁷ aa 27 Registry Manager , Swespine.

PMID: 25828191
PMCID: PMC4564773
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 et al. Acta Orthop. 2015.

. 2015;86(5):523-33.

doi: 10.3109/17453674.2015.1036696.

Authors

Affiliations

¹ a 1 Department of Orthopaedic Surgery, University of North Carolina Hospitals , Chapel Hill, NC, USA.
² b 2 Boston Consulting Group , Stockholm, Sweden.
³ c 3 International Consortium for Health Outcomes Measurement , Boston, MA, USA.
⁴ d 4 Department of Orthopaedics, Massachusetts General Hospital , Boston, MA, USA.
⁵ e 5 Department of Orthopaedic Surgery , Singapore General Hospital, Singapore.
⁶ f 6 Patient representative , Brisbane, Australia.
⁷ g 7 Nuffield Orthopaedic Centre, University of Oxford , Oxford, UK.
⁸ h 8 Department of Neurosurgery, University of Tennessee Health Science Center , Memphis, TN, USA.
⁹ i 9 Department of Orthopaedic Surgery, Spine Section, Rigshospitalet, University Hospital of Copenhagen , Copenhagen, Denmark.
¹⁰ j 10 Spine Center Göteborg , Gothenburg, Sweden.
¹¹ k 11 Department of Neurosurgery, Leiden University Medical Center , Leiden, the Netherlands.
¹² l 12 BrizBrain and Spine , Brisbane, Australia.
¹³ m 13 Department of Orthopaedics, Division of Spine, Ohio State University , Wexner Medical Center, Columbus, OH, USA.
¹⁴ n 14 Texas Back Institute , Plano, TX, USA.
¹⁵ o 15 Newro Foundation , Brisbane, Australia.
¹⁶ p 16 Department of Neurosurgery, Leiden University Medical Center and Medical Center Haaglanden , Leiden and The Hague, the Netherlands.
¹⁷ q 17 Director, Spine SCOAP Collaborative, Rainier Orthopedic Institute , Puyallup, WA, US.
¹⁸ r 18 Department of Orthopaedic Surgery, PM&R Section, Stanford University , Palo Alto, CA, USA.
¹⁹ s 19 Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway , Tromsø, Norway.
²⁰ t 20 The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority , Tromsø, Norway.
²¹ u 21 Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital , Lund, Sweden.
²² v 22 Sint Maartenskliniek, Research , Nijmegen, the Netherlands.
²³ w 23 Department of Anesthesiology , University of Pittsburgh Medical Center Pittsburgh, PA, USA.
²⁴ x 24 Maastricht University Medical Center , Maastricht, the Netherlands.
²⁵ y 25 Orthopaedic Diagnostic Centre , Singapore General Hospital, Singapore.
²⁶ z 26 Department of Orthopaedic Surgery, Ryhov Hospital , Jönköping, Sweden.
²⁷ aa 27 Registry Manager , Swespine.

PMID: 25828191
PMCID: PMC4564773
DOI: 10.3109/17453674.2015.1036696

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.**
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.**
The recommended timeline for collection of each outcome measure.

**Figure 3.**
A classification scheme to define interventions as either index events or reoperations.

See this image and copyright information in PMC

Comment in

Acta Orthop. 2016 Feb;87(1):89-90
Spinal disorders, quality-based healthcare and spinal registers.
Fairbank J. Fairbank J. Acta Orthop. 2015;86(5):521-2. doi: 10.3109/17453674.2015.1072431. Epub 2015 Jul 13. Acta Orthop. 2015. PMID: 26169065 Free PMC article. No abstract available.
A proposed set of metrics for standardized outcome reporting in the management of low back pain.
Werneke M. Werneke M. Acta Orthop. 2016 Feb;87(1):88. doi: 10.3109/17453674.2015.1120127. Epub 2015 Nov 26. Acta Orthop. 2016. PMID: 26610164 Free PMC article. No abstract available.

References

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

Affiliations

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

Authors

Affiliations

Abstract

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Comment in

References

MeSH terms

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Full Text Sources

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Medical

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