The rationale for primary spine care employing biopsychosocial, stratified and diagnosis-based care-pathways at a chiropractic college public clinic: a literature review.

Robb Russell

doi:10.1186/2045-709x-21-19

Abstract

Current management practices for low back pain have led to rising costs without evidence of improvement in the quality of care. Low back pain remains a diagnostic and management challenge for practitioners of many types and is now thought to be a leading global cause of disability. Beyond many published clinical practice guidelines, there are emerging, evidence-based care-pathways including stratification according to the patient's prognosis, classification-based management, diagnosis-based clinical decision guides and biopsychosocial models of care. A proposed solution for successfully addressing low back pain is to train residents at a chiropractic college public clinic to function as primary spine care practitioners, employing evidence-based care-pathways. The rationale for such is described with expected benefits to patient care, improved financial health of medical delivery systems and the training of chiropractors to successfully fill a niche in the healthcare system.

Highlights

Low back pain (LBP) is one of the most common health complaints, affecting eight out of ten people at some time in their lives [1]
A recent systematic review concluded LBP to be a major problem throughout the world, with the highest prevalence among females and those aged 40–80 years with a point prevalence of 11.9 ± 2.0% and a 1-month prevalence estimated of 23.2 ± 2.9% [4]
This paper proposes that any solution for LBP must provide superior clinical outcomes to current practices, create economic value and be based on standardization of care that makes patients, not practitioners, central in the care model

Summary

Introduction

Low back pain (LBP) is one of the most common health complaints, affecting eight out of ten people at some time in their lives [1]. Murphy and Hurwitz cite their approach, the previously described diagnosis-based clinical decision guide, as one that attempts to respond to the challenge of applying the biopsychosocial model and providing individualized treatment programs based on the particular diagnostic features of each patient [11]. Patients with LBP who were screened with SBST and treated in the corresponding categories had superior short and long-term disability, quality of life measures and cost savings compared with controls who received treatment considered to be current best practice [36] Use of this screening tool appears to be suitable in a clinical setting and it may provide important prognostic information for the management of LBP [37]. Their results suggest that the SBST can be used instead of multiple risk questionnaires to measure recovery from LBP [38]

Conclusions

NIH: National Center for Complementary and Alternative Medicine

21. Jacob G

Findings

26. McKenzie R: The Lumbar Spine