Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.

The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. These slides can be retrieved under Electronic Supplementary Material.

A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.

An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. These slides can be retrieved under Electronic Supplementary Material.

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SUMMARYThere are no data on the efficacy of a back school in primary prevention of back pain in the general population or on the characteristics of the population who volunteers. After announcement in the local press, 494 healthy adults volunteered and paid for a back school course in Switzerland. A total of 371 controls were matched for sex, age, profession, nationality and back pain. A statistically significant decrease in numbers of doctor's visits was found by the participants during the following 6 months compared with the controls. However, there were no significant between-group differences in the four remaining parameters (presence and intensity of back pain, drug intake and sick leave). Three-quarters of participants changed their attitudes after the back school. Volunteering for a back pain prevention programme was associated with the presence of back pain problems. Reasons for volunteering are further discussed. Overall, the results of this study showed that a back school for the general population may not solve the problem of low back pain, but improves self-help in a subgroup of the population. Primary prevention programmes have also been developed to reduce the occurrence of low back pain. In primary prevention, studies with control groups and data on lost workdays are rare, and results of educational programmes are conflicting [26]. However, in prospective studies in industry, the expected rate of back pain [27], compensation claims [28] and absenteeism [29] has been reduced.The Swiss League against Rheumatism (SLR) started a nationwide back school programme for the general population in 1990. The first 772 participants were prospectively evaluated and compared to a sample of 593 control subjects.Primary prevention addresses healthy individuals. In patients, educational programmes aim at encouraging the patient to take part in the management of his back problem and to be an active agent in the recovery process, with the underlying assumption that motivation is linked to symptoms [30,31]. As participation in a programme such as the one evaluated in this study is voluntary, it raises the question of reasons for volunteering, especially when the course is intended for the general population and is organized outside of the workplace.The evaluation of this back school programme focused on two aspects: what impact does the back school have on the participants in terms of back pain (prevalence and intensity) and its consequences (number of doctor's visits, drug intake and sick leave); and who volunteers for such a programme. METHODS SettingThe SLR back school was widely advertised in the local press of major urban areas. It consisted of eight weekly lessons of 90 min in the evening. Participants were taught in small groups (7-12 participants) and were charged the equivalent of US$80.The lessons were given by a physiotherapist trained in back school education. A multidisciplinary team of health professionals of Swiss rehabilitation units had prepared a 200 page handbook as a didactic base for the teachers...

Psychological and social factors are important components to addressing low back pain and health care providers play an important role in empowering patients to take control of their spinal health outcomes. Patients should be included in negotiating their spinal treatment and establishing treatment goals through careful listening, reassurance, and information providing by the health care provider. Instruments need to be developed for people with low literacy in medically underserved areas and low- and middle-income countries, especially where psychological and social factors may be difficult to detect and are poorly addressed. These slides can be retrieved under Electronic Supplementary Material.