Effective Conservative Spine Care

#ThinkChiropractic

Low back pain (LBP) is a recurrent disorder that can occur anytime in a person’s life and 50% of people who experience LBP seek health care during an episode.[1] [2] At least 85% of those who do seek care are diagnosed as experiencing nonspecific/non-pathological LBP.[3] Effective management of LBP in the United States is challenging and therefore it is difficult to determine the best approach for each patient given the vast number of recommended conservative treatment options within our complex health care system.[4]

Researchers from Optum Health Care Solutions[5] in collaboration with researchers from the Jefferson School of Population Health[6] published an article in a 2013 edition of Population Health Management[7] titled, “Conservative Spine Care: Opportunities to Improve the Quality and Value of Care” that suggests the utilization of a “classification-based” model for the management of LBP which, in a clinical trial published September 29, 2011 in The Lancet, demonstrated practical potential for improving clinical outcomes and addressing incongruous utilization of services.[8] The STarT Back Screening Tool (SBST)[9] can be administered prior to initiating treatment and provides the portal of entry provider the opportunity to incorporate evidence-informed decision criteria and guidance regarding an appropriate conservative low back care pathway in which to place the patient.

The SBST approach changes the pattern of provider management and referral of LBP to coincide with primary care data that suggests approximately 55% of patients are at low risk of poor outcome (i.e. irrespective of treatment), 33% are at medium risk, and 12% are at high risk.[10] Using the SBST approach, low risk individuals usually benefit most from receiving reassurance and advice while treatment options for medium risk individuals are typically physiotherapy approaches to addressing pain and disability. However, providers who are skilled at cognitive-behavioral approaches in addition to physiotherapy interventions are best suited to render care to high risk individuals.[11]

When compared to current best practice, use of the SBST tool along with targeted treatments increased efficiency, improved clinical outcomes, and reduced health care costs. [4]

---

[1] Dagenais S, Haldeman S. Evidence-Based Management of Low Back Pain. St Louis, MO: Mosby, Inc. (Elsevier); 2012:1–2.

[2] Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat. 2005;13:13.

[3]Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.

[4] Kosloff, Thomas M., David Elton, Stephanie A. Shulman, Janice L. Clarke, Alexis Skoufalos, and Amanda Solis. "Conservative Spine Care: Opportunities toImprove the Quality and Value of Care." Population Health Management. Mary Ann Liebert, Inc., 01 Dec. 2013. Web. 01 Feb. 2017.

[5] A health services and innovation company whose mission is to help make the health system work better for everyone.

[6] A college whose mission is to prepare leaders with global vision to examine the social determinants of health and to evaluate, develop and implement health policies and systems that will improve the health of populations and thereby enhance the quality of life.

[7] A journal that provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices.

[8] Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary caremanagement for low back pain with current best practice (STarT Back): A randomisedcontrolled trial. Lancet. 2011;378(9802):1560–1571. https://www.youtube.com/watch?v=yVu6w_01p9k

[9] Developed by researchers at Keele University (United Kingdom) with funding from Arthritis Research UK

[10] Hill JC, Dunn KM, Lewis M, et al. A primary care back pain screening tool: Identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59:632–641.

[11] Sowden G, Hill JC, Konstantinou K, et al. Targeted treatment in primary care for lowback pain: the treatment system and clinical training programmes used in theIMPaCT Back study (ISRCTN 55174281). Fam Pract. 2012;29:50–62.