New care guidelines for lower back pain
Evidence-based standards
A newly published study provides an evidence-based guide of 27 clinical indicators for appropriate low back pain (LBP) care.
In Australia, on average, only 60% of care is delivered in line with consensus-based guidelines, with a commonly cited barrier to appropriate care being the clinical practice guidelines (CPG) themselves. LBP is the largest contributor to the global burden of disability, with delivery of care spanning numerous sectors including primary care, Emergency Departments, and specialist settings. There are currently many CPGs that exist for the treatment of LBP; however, many are not user friendly, lack transparency, and have mixed strength of evidence underpinning them.
To address these issues, a group of researchers and clinicians formed the STANDING collaboration, with the aim of tackling the need for nationally agreed upon standards of care. In the article, What Constitutes ‘Appropriate Care’ for Low Back Pain? Point-of-Care Clinical Indicators from Guideline Evidence and Experts (the STANDING Collaboration project), published in Spine, the authors found 27 indicators that covered all aspects of LBP care, from 13 evidence sources and 299 CPG recommendations.
Most of the LBP indicators covered key care concepts such as healthcare practitioners undertaking a comprehensive and targeted history and examination to identify serious conditions, and factors which may delay recovery; providing education and advice; partnering with consumers to co-develop a management and monitoring plan for ongoing review of progress and those that are meaningful to the person; and appropriate on-referral (e.g. for serious conditions, physical and/or psychological treatment programmes).
Just under one quarter of the final indicator set focused on LBP care that should not be provided, such as unnecessary imaging and investigations, inappropriate prescribing of medicines, and non-evidence-based and low value treatment modalities such as electrotherapy).
Researcher Dr Louise Wiles, says “We know that 1 in 6 Australians (approximately 4 million people) experience LBP, and that for nearly 40% of them, their ability to go about their usual daily activities is at least moderately affected.
We know that the healthcare people receive for LBP is often not evidence-based.
Dr Wiles continues, “What is important and novel about this research is that our indicators have been developed collaboratively by a panel of clinicians, researchers, policy-makers and consumers, and are written in plain English; in this way we hope that our indicators can be a credible resource for both clinicians and consumers to use together to make decisions about evidence-based healthcare that is tailored to the individual person.”
Co-author Associate Professor Peter Hibbert is available for comment.
Read the journal article here or request a copy:
Wiles LK, Hibbert PD, Stephens JH, Molloy C, Maher CG, Buchbinder R, Moseley GL, O'Sullivan PB, Lin I, Briggs AM, Slater H, Harris IA, Jan S, Dwyer A, Fallon K, Hogg M, Fried K, Needs C, Casey P, Dabestani R, Kay D, Braithwaite J, Runciman WB. What Constitutes "Appropriate Care" for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project). Spine (Phila Pa 1976). 2021 Nov 17. doi: 10.1097/BRS.0000000000004274. Epub ahead of print. PMID: 34798647.
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