The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities

Abstract

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 Global Spine Care Initiative: resources to implement a spine care program

“…The hope is to avoid the increasing use of highcost, high-tech passive interventions which have become an increasing component of spine care in high-income countries and which have not been shown to have a major impact on spine-related disability [24]. This article identifies the resources necessary to achieve an evidence-based spine care delivery system which is patient-centered and takes into account the patient and community needs and priorities [25].…”

“…The Global Spine Care Initiative (GSCI) has developed a model of spine care that is based on the GSCI classification system and care pathway, and foundational papers [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The GSCI model of care has been developed so that it could be implemented in different settings with variable levels of health and community resources.…”

The Global Spine Care Initiative: care pathway for people with spine-related concerns

“…(2) non-invasive treatment; (3) invasive treatment; (4) psychological and social; (5) prevention and public health; and (6) specialty care and interdisciplinary/multidisciplinary management [24][25][26][27][28][29]. A review of the literature on compression fractures was included as a case study for spinal symptoms related to systemic pathology, in part because many patients with compression fractures can be managed in a primary spine care setting.…”

The Global Spine Care Initiative: classification system for spine-related concerns

“…Clinicians in general practice see people with minor symptoms or concerns who either may seek advice for prevention or may be seeking care for another complaint. It was recommended that any model of care should include guidance on current evidence as defined in the GSCI papers concerning prevention including risk factors, comorbidities, and the importance of psychosocial concerns that could lead to over-medicalization [24][25][26][27][28][29][30]. Primary and secondary prevention measures, whether applied at a population or individual level, could potentially reduce further the burden of spine disorders when applied to the specific needs of any given community [28,30].…”