Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Correspondence

Integrative care for the management of low back pain: use of a clinical care pathway

Authors: Michele J Maiers, Kristine K Westrom, Claire G Legendre, Gert Bronfort

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial.

Methods

A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study.

Results

Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans.

Conclusion

This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting.

Trial registration

ClinicalTrials.gov NCT00567333
Appendix
Available only for authorised users
Literature
1.
Bronfort G, Haas M, Evans RL, Bouter LM: Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004, 4: 335-356. 10.1016/j.spinee.2003.06.002.CrossRefPubMed
2.
van Tulder M, Koes B: Low back pain (chronic). Clin Evid. 2006, 15: 1634-1653.PubMed
3.
Airaksinen O, Hildebrandt J, Mannion AF: European Guidelines for the Management of Chronic Non-specific Low Back Pain. 2004
4.
Howarth ML, Haigh C: The myth of patient centrality in integrated care: the case of back pain services. International Journal of Integrated Care. 2007, 7: 1-8.CrossRef
5.
Boon H, Verhoef M, O'Hara D, Findlay B: From parallel practice to integrative health care: a conceptual framework. BMC Health Serv Res. 2004, 4: 15-10.1186/1472-6963-4-15.CrossRefPubMedPubMedCentral
6.
Boon H, Verhoef M, O'Hara D, Findlay B, Majid N: Integrative healthcare: arriving at a working definition. Altern Ther Health Med. 2004, 10: 48-56.PubMed
7.
Ivey SL, Brown KS, Teske Y, Silverman D: A model for teaching about interdisciplinary practice in health care settings. J Allied Health. 1988, 17: 189-195.PubMed
8.
Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C: Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ. 2001, 322: 1511-1516. 10.1136/bmj.322.7301.1511.CrossRefPubMedPubMedCentral
9.
Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B: Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003, CD002193.
10.
11.
Kodner DL, Spreeuwenberg C: Integrated care: meaning, logic, applications, and implications--a discussion paper. Int J Integr Care. 2002, 2: e12.CrossRefPubMed
12.
Haldorsen EM, Grasdal AL, Skouen JS, Risa AE, Kronholm K, Ursin H: Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain. 2002, 95: 49-63. 10.1016/S0304-3959(01)00374-8.CrossRefPubMed
13.
14.
15.
16.
Renholm M, Leino-Kilpi H, Suominen T: Critical pathways. A systematic review. J Nurs Adm. 2002, 32: 196-202. 10.1097/00005110-200204000-00008.CrossRefPubMed
17.
Westrom KK, Maiers MJ, Evans RL, Bronfort G: Individualized chiropractic and integrative care for low back pain: the design of a randomized clinical trial using a mixed-methods approach. Trials. 2010, 11: 24-10.1186/1745-6215-11-24.CrossRefPubMedPubMedCentral
18.
van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM: Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine. 2003, 28: 1978-1992. 10.1097/01.BRS.0000090503.38830.AD.CrossRefPubMed
19.
Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW: Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008, CD000396.
20.
Ostelo RW, van Tulder MW, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ: Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2005, CD002014.
21.
Hoffman BM, Papas RK, Chatkoff DK, Kerns RD: Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007, 26: 1-9. 10.1037/0278-6133.26.1.1.CrossRefPubMed
22.
Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005, 20: CD000335.
23.
Furlan AD, Imamura M, Dryden T, Irvin E: Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group. Spine. 2009, 34: 1669-1684. 10.1097/BRS.0b013e3181ad7bd6.CrossRefPubMed
24.
Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B: Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine. 2005, 30: 944-963. 10.1097/01.brs.0000158941.21571.01.CrossRefPubMed
25.
Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S: Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976). 2008, 33: E887-E900.CrossRef
26.
Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004, CD000447.
27.
Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S: Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine J. 2008, 8: 213-225. 10.1016/j.spinee.2007.10.023.CrossRefPubMed
28.
Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007, 147: 492-504.CrossRefPubMed
29.
Spitzer WO: Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987, 12: S1-S59. 10.1097/00007632-198701000-00001.CrossRef
30.
31.
Tuckman BW: Developmental sequence in small groups. Psychol Bull. 1965, 63: 384-399. 10.1037/h0022100.CrossRefPubMed
32.
Patrick DL: Assessing health-related quality of life in patients with sciatica. Spine. 1995, 20: 1899-1909. 10.1097/00007632-199509000-00011.CrossRefPubMed
33.
Beurskens AJ, de Vet HC, Koke AJ: Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996, 65: 71-76. 10.1016/0304-3959(95)00149-2.CrossRefPubMed
34.
Brazier J, Deverill M, Green C: A review of the use of health status measures in economic evaluation. J Health Serv Res Policy. 1999, 4: 174-184.PubMed
35.
The EuroQol Group: EuroQol -- a new facility for the measurement of health-related quality of life. Health Policy. 1990, 16: 199-206. 10.1016/0168-8510(90)90421-9.CrossRef
36.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ: A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993, 52: 157-168. 10.1016/0304-3959(93)90127-B.CrossRefPubMed
37.
French DJ, France CR, Vigneau F, French JA, Evans RT: Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain. 2007, 127: 42-51. 10.1016/j.pain.2006.07.016.CrossRefPubMed
38.
Brown GK, Nicassio PM: Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain. 1987, 31: 53-64. 10.1016/0304-3959(87)90006-6.CrossRefPubMed
39.
Mercado AS, Carroll LJ, Cassidy JD, Cote P: Coping with neck and low back pain in the general population. Health Psychol. 2000, 19: 333-338. 10.1037/0278-6133.19.4.333.CrossRefPubMed
40.
Nicholas MK: The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2006, 11: 153-163. 10.1016/j.ejpain.2005.12.008.CrossRefPubMed
41.
Radloff LS: The CES-depression scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1972, 1: 385-401. 10.1177/014662167700100306.CrossRef
42.
Devins GM, Orme CM, Costello CG, Binik YM, Frizzell B, Stam HJ, Pullin WM: Measuring depressive symptoms in illness populations: psychometric properties of the center for epidemiologic studies depression (CES-D) scale. Psychology and Health. 1998, 2: 139-156.CrossRef
43.
Medical Research Council: A framework for development and evaluation of RCTs for complex interventions to improve health. London. 2000
Metadata
Title
Integrative care for the management of low back pain: use of a clinical care pathway
Authors
Michele J Maiers
Kristine K Westrom
Claire G Legendre
Gert Bronfort
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-298

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue

Research article

Public views on a wait time management initiative: a matter of communication

Research article

Health need and the use of alternative medicine among adults who do not use conventional medicine

Research article

Evaluation of computerized health management information system for primary health care in rural India

Debate

Reorienting programme budgeting and marginal analysis (PBMA) towards disinvestment

Research article

Practitioners' validation of framework of team-oriented practice models in integrative health care: a mixed methods study

Study protocol

What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol