Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 3;19(1):11.
doi: 10.1186/s13018-023-04492-z.

Development of a low back pain care pathway in an academic hospital system: results of a consensus process

Geronimo Bejarano  1 , Robert Vining  2 , Devan P Desai  3 , Joe Minchew  3 , H Michael Guo  3 , Christine Goertz  4
Affiliations

Development of a low back pain care pathway in an academic hospital system: results of a consensus process

Geronimo Bejarano et al. J Orthop Surg Res. .

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.

Keywords: Care pathway; Chiropractic; Clinical practice guideline; Delphi; Low back pain; Physical therapy; Spinal pain.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Final care pathway for LBP
See this image and copyright information in PMC

References

    1. Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM. The global burden of musculoskeletal pain—where to from here? Am J Public Health. 2019;109(1):35–40. doi: 10.2105/AJPH.2018.304747. - DOI - PMC - PubMed
    1. GBD 2016 DALYs and HALE Collaborators Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Lond Engl. 2017;390(10100):1260–1344. doi: 10.1016/S0140-6736(17)32130-X. - DOI - PMC - PubMed
    1. Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, et al. US Health care spending by payer and health condition, 1996–2016. JAMA. 2020;323(9):863–884. doi: 10.1001/jama.2020.0734. - DOI - PMC - PubMed
    1. Fritz JM, Cleland JA, Brennan GP. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists? Med Care. 2007;45(10):973–980. doi: 10.1097/MLR.0b013e318070c6cd. - DOI - PubMed
    1. Rutten GM, Degen S, Hendriks EJ, Braspenning JC, Harting J, Oostendorp RA. Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit? Phys Ther. 2010;90(8):1111–1122. doi: 10.2522/ptj.20090173. - DOI - PubMed

LinkOut - more resources