Clinical guidelines and care pathway for management of low back pain with or without radicular pain

Bailly, Franck; Trouvin, Anne-Priscille; Sandrine, Bercier; Dadoun, Sabrina; Deneuville, Jean-Philippe; Rogatien, Faguer; Fassier, Jean‐Baptiste; Koleck, Michèle; Lassalle, Louis; Vraux, Thomas Le; Brigitte, Liesse; Petitprez, Karine; Aline, Ramond-Roquin; Renard, Jean-FranÃ Ois; Alexandra, Roren; Rozenberg, Sylvie; Sebire, Catherine; Vuides, Gilles; Rannou, F.; Petit, Audrey

doi:10.1016/j.jbspin.2021.105227

Cited by 36 publications

(54 citation statements)

References 29 publications

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“… Physiotherapy interventions categories based on clinical practice guidelines and systematic reviews selected [ 21 – 24 ] The physiotherapy prescription provided by the general practitioner to the patient is mandatory for the physiotherapist to be able to take care of the patient and thus have the costs covered by the French Health Insurance * Chi-squared test or Fisher’s exact test with significant value (p < 0.05) used to compare prescribed interventions prescribed/recommended to all spinal pain patients † Such as advice on daily physical activity ‡ Defined as coordination, endurance, strengthening or postural exercises. ¤ Defined as primarily range of motion and strengthening exercise of the whole body.…”

Section: Resultsmentioning

confidence: 99%

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Spinal pain patients seeking care in primary care and referred to physiotherapy: A cross-sectional study on patients characteristics, referral information and physiotherapy care offered by general practitioners and physiotherapists in France

et al. 2022

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Objectives To describe spinal pain patients referred by their treating general practitioners to physiotherapy care, examine to which extent physiotherapy interventions proposed by general practitioners and physiotherapists were compliant to evidence based recommendations, and evaluate concordance between providers in terms of diagnosis and contraindications to physiotherapy interventions. Methods This study included spinal pain patients recruited from a random sample of sixty French physiotherapists. Physiotherapists were asked to supply patients’ physiotherapy records and characteristics from the general practitioner’s physiotherapy referral for the five new consecutive patients referred to physiotherapy. General practitioner’s physiotherapy referral and physiotherapists’ clinical findings characteristics were analyzed and compared to evidence-based recommendations using Chi-squared tests. Cohen’s kappas were calculated for diagnosis and contraindications to physiotherapy interventions. Results Three hundred patients with spinal pain were included from sixty physiotherapists across France. The mean age of the patients was 48.0 ± 7.2 years and 53% were female. The most common spinal pain was low back pain (n = 147). Diagnoses or reason of referral formulated by general practitioners were present for 27% of all patients (n = 82). Compared to general practitioners, physiotherapists recommended significantly more frequently recommended interventions such as education, spinal exercises or manual therapy. General practitioners prescribed significantly more frequently passive physiotherapy approaches such as massage therapy and electrotherapy. The overall proportion of agreement beyond chance for identification of a diagnosis or reason of referral was 41% with a weak concordance (κ = 0.19; 95%CI: 0.08–0.31). The overall proportion of compliant physiotherapists was significantly higher than for general practitioners (76.7% vs 47.0%; p<0.001). Conclusions We found that information required for the referral of spinal pain patients to physiotherapy is often incomplete. The majority of general practitioners did not conform to evidence-based recommendations in terms of prescribed specific physiotherapy care; in contrast to a majority of physiotherapists. Trial registration ClinicalTrials.gov: NCT04177121

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Section: Resultsmentioning

confidence: 99%

“… Physiotherapy interventions categories based on clinical practice guidelines and systematic reviews selected [ 21 – 24 ] …”

Section: Resultsmentioning

confidence: 99%

Spinal pain patients seeking care in primary care and referred to physiotherapy: A cross-sectional study on patients characteristics, referral information and physiotherapy care offered by general practitioners and physiotherapists in France

et al. 2022

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“…For the management of LBP, most guidelines recommend SMT, with some discrepancies regarding the circumstances in which it should be administered ( 19 , 125 ). For example, the United Kingdom's National Institute for Health and Care Excellence (NICE) guidelines make it imperative that SMT be offered alongside exercise therapy for LBP irrespective of the stage ( 113 ).…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

“…This is reflected in the recent publication of systematic reviews and clinical practice guidelines exclusively devoted to summarizing the evidence and recommendations for noninvasive treatments for neck pain (NP) and LBP (16)(17)(18). Among these interventions, manual therapy is frequently recommended as one of many front-line options for spine pain (13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

et al. 2021

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Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

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“…Risk-based strati ed care, for example using the STarT Back tool [9], is now recommended for LBP internationally in a number of clinical guidelines [10,11,12].…”

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confidence: 99%

Risk-based stratified primary care for common musculoskeletal pain presentations: qualitative findings from the STarT MSK cluster randomised controlled trial

Saunders

Chudyk

Protheroe

et al. 2022

Preprint

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BackgroundThe STarT MSK cluster randomised controlled trial (RCT) investigated the clinical- and cost-effectiveness of risk-based stratified primary care versus usual care for patients with back, neck, shoulder, knee or multi-site pain. Trial quantitative results showed risk-based stratified care was not superior to usual care for patients’ clinical outcomes, but the intervention led to some changes in GP clinical decision-making. This paper reports a nested qualitative study exploring how risk-based stratified care was perceived and used in the trial, from the perspectives of clinicians and patients.MethodsSemi-structured interviews were conducted with 27 patients, and focus groups and interviews with 20 clinicians (GPs and physiotherapists) in the intervention arm of the trial. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and the COM-B model.ResultsRisk-based stratified care (subgrouping and matching treatments) was found to have ‘coherence’ (i.e. made sense) to several clinicians and patients, in that it was well-integrated in practice, and supported clinical decision-making. However, for some GPs stratified care was less ‘meaningful’, as the risk-stratification tool did not fit with usual ways of consulting and added to already time-pressured consultations. GPs reported giving more patients written information/advice due to easier access to electronic information leaflets through the trial template and were motivated to refer patients to physiotherapy as they believed the trial resulted in faster physiotherapy access (although this was not the case). Patients and clinicians reported that risk-based stratified care influenced conversations in the consultation, prompting greater attention to psychosocial factors, and facilitating negotiation of treatment options. Physiotherapists saw benefits in receiving information about patients’ risk subgroup on referral forms.ConclusionThese findings provide context for interpreting some of the trial outcomes, particularly in relation to changes in clinical decision-making when risk-based stratified care was used. Findings also indicate potential reasons for lack of GP engagement with risk-based stratified care. Positive outcomes were identified that were not captured in the quantitative data, specifically that risk-based stratified care positively influenced some GP-patient conversations and facilitated negotiation of treatment options.Trial registration: ISRCTN15366334 (26/04/2016)

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Clinical guidelines and care pathway for management of low back pain with or without radicular pain

Cited by 36 publications

References 29 publications

Spinal pain patients seeking care in primary care and referred to physiotherapy: A cross-sectional study on patients characteristics, referral information and physiotherapy care offered by general practitioners and physiotherapists in France

Spinal pain patients seeking care in primary care and referred to physiotherapy: A cross-sectional study on patients characteristics, referral information and physiotherapy care offered by general practitioners and physiotherapists in France

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

Risk-based stratified primary care for common musculoskeletal pain presentations: qualitative findings from the STarT MSK cluster randomised controlled trial

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