TY - JOUR
T1 - What Constitutes "Appropriate Care" for Low Back Pain?
T2 - Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project)
AU - Wiles, Louise K.
AU - Hibbert, Peter D.
AU - Stephens, Jacqueline H.
AU - Molloy, Charlotte
AU - Maher, Chris G.
AU - Buchbinder, Rachelle
AU - Moseley, G. Lorimer
AU - O'Sullivan, Peter B.
AU - Lin, Ivan
AU - Briggs, Andrew M.
AU - Slater, Helen
AU - Harris, Ian A.
AU - Jan, Stephen
AU - Dwyer, Andrew
AU - Fallon, Kieran
AU - Hogg, Malcolm
AU - Fried, Kal
AU - Needs, Chris
AU - Casey, Petrina
AU - Dabestani, Roya
AU - Kay, Debra
AU - Braithwaite, Jeffrey
AU - Runciman, William B.
PY - 2022/6/15
Y1 - 2022/6/15
N2 - STUDY DESIGN: Multiround wiki-based Delphi expert panel survey.OBJECTIVE: To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP).SUMMARY OF BACKGROUND DATA: The provision of inappropriate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recommendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care."METHODS: Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators.RESULTS: From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators comprising screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided.CONCLUSION: These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.
AB - STUDY DESIGN: Multiround wiki-based Delphi expert panel survey.OBJECTIVE: To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP).SUMMARY OF BACKGROUND DATA: The provision of inappropriate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recommendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care."METHODS: Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators.RESULTS: From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators comprising screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided.CONCLUSION: These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.
UR - http://www.scopus.com/inward/record.url?scp=85130148378&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004274
DO - 10.1097/BRS.0000000000004274
M3 - Article
C2 - 34798647
SN - 0362-2436
VL - 47
SP - 879
EP - 891
JO - Spine
JF - Spine
IS - 12
ER -