Perspective of Value-Based Management of Spinal Disorders in Brazil

Teles, Alisson Roberto; Righesso, Orlando; Gullo, Maria Carolina Rosa; Ghogawala, Zoher; Falavigna, Asdrúbal

doi:10.1016/j.wneu.2015.11.047

Cited by 14 publications

(14 citation statements)

References 51 publications

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“… 11 Another survey among the Latin-American AOSpine members reported familiarity with generic PROMs in 79% of 199 participants and familiarity with disease-specific PROMs in 86%. 18 In our study, 45% of surgeons were familiar with generic and 55% with disease-specific PROMs. Interestingly, familiarity varied according to surgical specialisation and geographic region and was in general higher for disease-specific PROMs than for generic PROMs.…”

Section: Discussionmentioning

confidence: 71%

“…Moreover, the quality of healthcare delivery can be monitored and improved. 18 25 28 29 Our factor analysis of the questionnaire showed that surgeons see four broad categories of reasons for using PROMs: to improve the quality of care; to contribute to the measurement of outcomes; compliance with regulation and that PROMs should be limited to the assessment of individual patient outcomes.…”

Section: Discussionmentioning

confidence: 96%

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Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

et al. 2018

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ObjectiveTo gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs.DesignOnline survey.ParticipantsSurgeons who are members of the AO Foundation.MeasuresParticipants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ2 tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage.Results1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine.ConclusionsOur survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 96%

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

et al. 2018

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“…Imaging rates for low back pain also seem to be inappropriately high in several low-income and middleincome countries, including India, 44 China, 45 Iran, 46 Brazil, 40 and Russia, 47 and although the availability of published data is limited, those that are available (from Brazil) suggest large increases in spinal surgery costs over the past 20 years. 65 The paucity of comparative data makes comparisons of high-income, low-income, and middle-income countries challenging. However, the examples in panel 1 seem to suggest greater use of advice to rest and of passive electrical modalities in low-income and middle-income countries.…”

Section: The Global Gap Between Evidence and Practicementioning

confidence: 99%

Prevention and treatment of low back pain: evidence, challenges, and promising directions

Anema²,

et al. 2018

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Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.

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“…11 While the precise direct and indirect costs of LBP in Brazil is presently unknown, a 226% increase in the number of spinal surgeries and a 540% increase in the costs of spine surgery in the country has been observed from 1995 to 2014. 15,16 Loss of productivity due to sick leave and early retirement are also a concern for the Brazilian economy and society. Spinal pain is the leading cause of compensation claims, representing 17.5% of all benefit claims in the last five years in Brazil.…”

Section: An Overview Of the Brazilian Health System And The Burden Ofmentioning

confidence: 99%

Tackling low back pain in Brazil: a wake-up call

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Costa

Stein

et al. 2019

Brazilian Journal of Physical Therapy

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Background: Low back pain is the leading cause of years lived with disability in Brazil based upon Global Burden of Disease estimates. Since 1990, the number of years lived with disability has increased by 79.7%, and this number is expected to continue to rise due to population growth and ageing. Yet, similarly to other countries, little attention has been given to it in both the public and private health systems, arguably making it an overlooked epidemic in Brazil. There is evidence that Brazil has adopted unwarranted practices in the management of low back pain in a similar manner to what has been observed in high-income countries. To tackle the burden of low back pain in Brazil, we need highly coordinated efforts from government, the private sector, universities, health workers and civil society. Objective: This masterclass intends to provide an overview of the challenges faced by Brazil in relation to low back pain management and propose potential solutions that could potentially be implemented based on experiences reported in the literature.

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Perspective of Value-Based Management of Spinal Disorders in Brazil

Cited by 14 publications

References 51 publications

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

Prevention and treatment of low back pain: evidence, challenges, and promising directions

Tackling low back pain in Brazil: a wake-up call

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