SPECIAL ARTICLE  LOW BACK PAIN UPDATE AND THE BELGIAN EXAMPLE Free access

European Journal of Physical and Rehabilitation Medicine 2020 April;56(2):228-36

DOI: 10.23736/S1973-9087.19.05984-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The pivotal role for the multidisciplinary approach at all phases and at all levels in the national pathway for the management of low back pain and radicular pain in Belgium

Bart DEPREITERE ¹ ✉, Pascale JONCKHEER ², Ellen COECKELBERGHS ³, Anja DESOMER ², Peter van WAMBEKE ⁴

¹ Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium; ² Belgian Health Care Knowledge Centre, Brussels, Belgium; ³ Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, Leuven, Belgium; ⁴ Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium

INTRODUCTION: High level evidence on management of spinal disorders is scarce, which results in guidelines being of limited practical use for practitioners. Care pathways are complex interventions intended for the mutual decision making of organization of care processes for a well-defined group of patients. The goal of this project was to design a pathway for the management of low back pain and radicular pain for national implementation in Belgium.
EVIDENCE ACQUISITION: An international and Belgian study on characteristics of low back pain care pathways was performed along with a literature study and focus group interrogation. Based on essential building elements identified and a consensus approach among all relevant stakeholders in primary, hospital and reintegration care, a national pathway was constructed. The process was endorsed by the Belgian Health Care Knowledge Center, Belgian National Institute of Health and Disability Insurance and the Spine Society of Belgium.
EVIDENCE SYNTHESIS: Eleven international pathways were identified, varying in implementation width from hospital-based to region/province-based. Seven Belgian pathway initiatives were detected. Notwithstanding differences, consistent building elements were identified. Three groups of caregivers, divided in primary care, hospital care and reintegration and including all relevant medical/paramedical disciplines, worked on integrating the essential building elements into a single concrete patient pathway of direct use to any caregiver and patient and based on a consensus model including reference to the 2017 Belgian adaptation of the 2016 NICE guidelines. The resulting pathways on management of low back pain and radicular pain underpin the importance of multidisciplinary teamwork.
CONCLUSIONS: Essential building elements were identified from literature and established pathways and were successfully integrated in a Belgian national low back pain and radicular pain pathway using an integrative consensus approach. The pathways are consultable at www.lowbackpain.kce.be.

KEY WORDS: Low back pain; Interdisciplinary research; National health programs