scholarly journals Treatment-Based Classification System for Low Back Pain: Revision and Update

2016 ◽  
Vol 96 (7) ◽  
pp. 1057-1066 ◽  
Author(s):  
Muhammad Alrwaily ◽  
Michael Timko ◽  
Michael Schneider ◽  
Joel Stevans ◽  
Christopher Bise ◽  
...  
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Care Provider ◽  
Care Provider ◽  
Function Optimization ◽  
Optimization Approach ◽  
Low Back ◽  
Disability Status ◽  
First Contact

Abstract The treatment-based classification (TBC) system for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. This perspective article describes how the TBC was updated by maintaining its strengths, addressing its limitations, and incorporating recent research developments. The current update of the TBC has 2 levels of triage: (1) the level of the first-contact health care provider and (2) the level of the rehabilitation provider. At the level of first-contact health care provider, the purpose of the triage is to determine whether the patient is an appropriate candidate for rehabilitation, either by ruling out serious pathologies and serious comorbidities or by determining whether the patient is appropriate for self-care management. At the level of the rehabilitation provider, the purpose of the triage is to determine the most appropriate rehabilitation approach given the patient's clinical presentation. Three rehabilitation approaches are described. A symptom modulation approach is described for patients with a recent—new or recurrent—LBP episode that has caused significant symptomatic features. A movement control approach is described for patients with moderate pain and disability status. A function optimization approach is described for patients with low pain and disability status. This perspective article emphasizes that psychological and comorbid status should be assessed and addressed in each patient. This updated TBC is linked to the American Physical Therapy Association's clinical practice guidelines for low back pain.

scholarly journals Designing an online resource for people with low back pain: health-care provider perspectives

2016 ◽  
Vol 22 (2) ◽  
pp. 159 ◽  
Author(s):  
Mandy Nielsen ◽  
Gwendolen Jull ◽  
Paul W. Hodges
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Care Provider ◽  
Care Provider ◽  
Health Care Professionals ◽  
Low Back ◽  
Care Providers ◽  
Management Options ◽  
Provider Perspectives

People with low back pain (LBP) seek education and information from the Internet. Existing LBP websites are often of poor quality, and disparities have been identified between patient and health-care provider evaluations of LBP websites. This study aimed to identify health-care provider perspectives on desirable content for a proposed LBP website and how this information should be presented. It complements an earlier study of LBP patient (consumer) perspectives. A qualitative descriptive study, encompassing focus groups and telephone interviews, was conducted with 42 health-care professionals practising in the LBP field. Four categories of information were identified: explaining LBP; treatment and management options; myth-busting information; and communication with health-care professionals. Presentation preferences included: use of visual media; interactivity; and useability and readability. Comparison with the consumer study identified differences with regard to: depth and breadth of diagnostic and treatment information; provision of lay person experiences and stories; and capacity for consumer-to-consumer interaction online. Views of both consumers and health-care providers are critical when developing an online LBP resource. Failure to address the needs of both stakeholder groups diminishes the potential of the resource to improve consumer outcomes.

Relationship between low back pain, disability, MR imaging findings and health care provider

2006 ◽  
Vol 35 (9) ◽  
pp. 641-647 ◽  
Author(s):  
Estanislao Arana ◽  
Luis Martí-Bonmatí ◽  
María Vega ◽  
Daniel Bautista ◽  
Enrique Mollá ◽  
...  
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Mr Imaging ◽  
Health Care Provider ◽  
Care Provider ◽  
Low Back ◽  
Imaging Findings ◽  
Pain Disability

scholarly journals Analgesic Usage for Low Back Pain: Impact on Health Care Costs and Service Use

Spine ◽  
2005 ◽  
Vol 30 (9) ◽  
pp. 1075-1081 ◽  
Author(s):  
Molly T. Vogt ◽  
C Kent Kwoh ◽  
Doris K. Cope ◽  
Thaddeus A. Osial ◽  
Michael Culyba ◽  
...  
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Care Costs ◽  
Service Use ◽  
Low Back ◽  
Care Costs

scholarly journals Use of Electronic Health Records for Early Detection of High-Cost, Low Back Pain Patients

2015 ◽  
Vol 20 (5) ◽  
pp. 234-240 ◽  
Author(s):  
Daniel D Maeng ◽  
Walter F Stewart ◽  
Xiaowei Yan ◽  
Joseph A Boscarino ◽  
Jack Mardekian ◽  
...  
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Low Back Pain ◽  
Back Pain ◽  
Care Provider ◽  
Regression Models ◽  
Low Back ◽  
Health Records ◽  
Logistic Regression Models ◽  
Electronic Health

BACKGROUND: Low back pain (LBP) is a debilitating condition that is complex to manage. One reason is that clinicians lack means to identify early on patients who are likely to become high care utilizers.OBJECTIVE: To explore the feasibility of developing a ‘dynamic’ predictive model using electronic health record data to identify costly LBP patients within the first year after their initial LBP encounter with a primary care provider. Dynamic, in this context, indicates a process in which the decision on how to manage patients is dependent on whether they are at their first, second or third LBP visit with the provider.METHODS: A series of logistic regression models was developed to predict who will be a high-cost patient (defined as top 30% of the cost distribution) at each of the first three LBP visits.RESULTS: The c-statistics of the three logistic regression models corresponding to each of the first three visits were 0.683, 0.795 and 0.741, respectively. The overall sensitivity of the model was 42%, the specificity was 86% and the positive predictive value was 48%. Men were more likely to become expensive than women, while patients who had workers’ compensation as their primary payer type had higher use of prescription opioid drugs or were smokers before the first LBP visit were also more likely to become expensive.CONCLUSION: The results suggest that it is feasible to develop a dynamic, primary care provider visit-based predictive model for LBP care based on longitudinal data obtained via electronic health records.

scholarly journals Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

2021 ◽  
Author(s):  
Kenneth Harwood ◽  
Jesse Pines ◽  
C. Holly A. Andrilla ◽  
Bianca K. Frogner
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Health Care Utilization ◽  
Index Date ◽  
Care Utilization ◽  
Low Back ◽  
Opioid Prescription ◽  
Serious Illness

Abstract Background: Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs. Methods: Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions, or an opioid prescription recorded in the six months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a common econometric technique, two-stage residual inclusion (2SRI) estimation to reduce selection bias in the choice of first provider, controlling for demographics.Results: Among 3,799,593 individuals, cost and utilization varied considerably based on first provider seen by the patient. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5,093) or primary care physician ($5,660), and highest when starting with an orthopedist ($9,434) or acupuncturist ($9,205). Conclusion: The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.

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