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European Spine Journal

, Volume 20, Issue 3, pp 369–379 | Cite as

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

  • J. T. Kessler
  • M. Melloh
  • Thomas Zweig
  • E. Aghayev
  • C. Röder
Original Article

Abstract

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new ‘Spine Tango conservative’ questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With ‘Spine Tango conservative’ a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.

Keywords

Spine Tango Registry Low back pain Neck pain Treatment Outcome measures 

Notes

Acknowledgments

We gratefully acknowledge the experts of the first round table: Norbert Boos, MD, MBA, Bogdan Radanov, MD, Florian Brunner, MD, PhD, Beat Wälchli, MD, DC. Furthermore, we would like to thank our international experts from stage two, John O’Dowd, MD and Margareta Nordin, PT, Dr. Sci. Last but not least we would like to thank all practitioners (Florian Brunner, MD, PhD, Daniel Meier, MD and Fredrik Granelli, DC), the team of physiotherapists at Balgrist University Hospital, Zurich (Evelyn Bärtschi, PT, Sibylle Früh, PT, Carolin Heitz, PT, MSc, Manuel Bischofberger, PT and Silvia Rauber, PT) and the osteopaths at the Center for Osteopathy Zurich (Marc Piske, CO and Hanspeter Stucki, CO) for providing us with patient treatment and patient data.

References

  1. 1.
    Aebi M, Grob D (2004) SSE Spine Tango: a European Spine Registry promoted by the Spine Society of Europe (SSE). Eur Spine J 13:661–662PubMedCrossRefGoogle Scholar
  2. 2.
    Aepli M, Mannion AF, Grob D (2009) Translaminar screw fixation of the lumbar spine: long-term outcome. Spine (Phila Pa 1976) 34:1492–1498. doi: 10.1097/BRS.0b013e3181a0934f Google Scholar
  3. 3.
    Ahmad N, Boutron I, Moher D, Pitrou I, Roy C, Ravaud P (2009) Neglected external validity in reports of randomized trials: the example of hip and knee osteoarthritis. Arthritis Rheum 61:361–369PubMedCrossRefGoogle Scholar
  4. 4.
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRefGoogle Scholar
  5. 5.
    Albright J, Allman R, Bonfiglio RP, Conill A, Dobkin B, Guccione AA et al (2001) Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 81:1641–1674Google Scholar
  6. 6.
    Audige L, Hanson B, Kopjar B (2006) Issues in the planning and conduct of non-randomised studies. Injury 37:340–348PubMedCrossRefGoogle Scholar
  7. 7.
    Baldwin ML (2004) Reducing the costs of work-related musculoskeletal disorders: targeting strategies to chronic disability cases. J Electromyogr Kinesiol 14:33–41PubMedCrossRefGoogle Scholar
  8. 8.
    Bouwmeester W, van Enst A, van Tulder M (2009) Quality of low back pain guidelines improved. Spine (Phila Pa 1976) 34:2562–2567. doi: 10.1097/BRS.0b013e3181b4d50d Google Scholar
  9. 9.
    Bronfort G, Haas M, Evans RL, Bouter LM (2004) Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 4:335–356PubMedCrossRefGoogle Scholar
  10. 10.
    Carey TS, Mielenz TJ (2007) Measuring outcomes in back care. Spine 32:S9–S14PubMedCrossRefGoogle Scholar
  11. 11.
    Cassidy JD, Carroll LJ, Cote P (1998) The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine 23:1860–1866 (discussion 1867).PubMedCrossRefGoogle Scholar
  12. 12.
    Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG (2003) A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med 138:898–906PubMedGoogle Scholar
  13. 13.
    Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147:478–491PubMedGoogle Scholar
  14. 14.
    Daykin AR, Richardson B (2004) Physiotherapists’ pain beliefs and their influence on the management of patients with chronic low back pain. Spine 29:783–795PubMedCrossRefGoogle Scholar
  15. 15.
    Ferrer M, Pellise F, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine 31:1372–1379 (discussion 1380)PubMedCrossRefGoogle Scholar
  16. 16.
    Fritzell P, Stromqvist B, Hagg O (2006) A practical approach to spine registers in Europe: the Swedish experience. Eur Spine J 15(Suppl 1):S57–S63PubMedCrossRefGoogle Scholar
  17. 17.
    Frymoyer JW (1988) Back pain and sciatica. N Engl J Med 318:291–300PubMedCrossRefGoogle Scholar
  18. 18.
    Frymoyer JW, Cats-Baril WL (1991) An overview of the incidences and costs of low back pain. Orthop Clin North Am 22:263–271PubMedGoogle Scholar
  19. 19.
    Giles LG (2001) Evidence-based clinical guidelines submitted to the Australian National Health and Medical Research Council for the management of acute low back pain: a critical review. J Manipulative Physiol Ther 24:131–139PubMedCrossRefGoogle Scholar
  20. 20.
    Hart LG, Deyo RA, Cherkin DC (1995) Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a US national survey. Spine 20:11–19PubMedCrossRefGoogle Scholar
  21. 21.
    Kendall NAS, Linton SJ, Main CJ (1997) Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee, WellingtonGoogle Scholar
  22. 22.
    Kirkaldy-Willis WH (1984) The relationship of structural pathology to the nerve root. Spine (Phila Pa 1976) 9:49–52Google Scholar
  23. 23.
    Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G (2001) Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 26:2504–2513 (discussion 2513–2504)PubMedCrossRefGoogle Scholar
  24. 24.
    Linstone HA, Turoff M (2002) The Delphi method: techniques and applications. 621Google Scholar
  25. 25.
    Luck J, Peabody JW, Lewis BL (2006) An automated scoring algorithm for computerized clinical vignettes: evaluating physician performance against explicit quality criteria. Int J Med Inform 75:701–707PubMedCrossRefGoogle Scholar
  26. 26.
    Maetzel A, Li L (2002) The economic burden of low back pain: a review of studies published between 1996 and 2001. Best Pract Res Clin Rheumatol 16:23–30PubMedCrossRefGoogle Scholar
  27. 27.
    Main CJ, Williams AC (2002) Musculoskeletal pain. BMJ 325:534–537PubMedCrossRefGoogle Scholar
  28. 28.
    Maniadakis N, Gray A (2000) The economic burden of back pain in the UK. Pain 84:95–103PubMedCrossRefGoogle Scholar
  29. 29.
    Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026PubMedCrossRefGoogle Scholar
  30. 30.
    McGuirk B, King W, Govind J, Lowry J, Bogduk N (2001) Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine 26:2615–2622PubMedCrossRefGoogle Scholar
  31. 31.
    Melloh M, Röder C, Staub LP, Zweig T, Barz T, Theis JC, Müller U (2010) Randomized controlled trials for surgical implants—are registries an alternative? J Orthop Sci (accepted for publication)Google Scholar
  32. 32.
    Melloh M, Staub L, Aghayev E, Zweig T, Barz T, Theis JC, Chavanne A, Grob D, Aebi M, Roeder C (2008) The International Spine Registry SPINE TANGO: status quo and first results. Eur Spine J 17:1201–1209. doi: 10.1007/s00586-008-0665-2 PubMedCrossRefGoogle Scholar
  33. 33.
    Mesrian A, Neubauer E, Schiltenwolf M (2007) Reduction in pain intensity after treatment for chronic back pain. When is it clinically meaningful? Schmerz 21:212, 214–217. doi: 10.1007/s00482-007-0543-6
  34. 34.
    Nachemson A, Jonsson E (2000) Neck and back pain: the scientific evidence of causes, diagnoses and treatment. Lippincott, Williams and Wilkins, PhiladelphiaGoogle Scholar
  35. 35.
    Oggier W (2007) Volkswirtschaftliche Kosten chronischer Schmerzen in der Schweiz—eine erste Annäherung. Schweizerische Ärztezeitung 88:1265–1269Google Scholar
  36. 36.
    Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M (2000) Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA 283:1715–1722PubMedCrossRefGoogle Scholar
  37. 37.
    Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M (2004) Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med 141:771–780PubMedGoogle Scholar
  38. 38.
    Porchet F, Bartanusz V, Kleinstueck FS, Lattig F, Jeszenszky D, Grob D, Mannion AF (2009) Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. Eur Spine J 18(Suppl 3):360–366. doi: 10.1007/s00586-009-0917-9 PubMedCrossRefGoogle Scholar
  39. 39.
    Rivero-Arias O, Campbell H, Gray A, Fairbank J, Frost H, Wilson-MacDonald J (2005) Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial. BMJ 330:1239PubMedCrossRefGoogle Scholar
  40. 40.
    Roder C, Blozik E, Muller U, Moulin P, Aebi M (2009) SWISSspine: an outcome and quality registry of orthopaedic implants as condition for reimbursement by basic health insurance. J Manage Market Healthcare 2:94–101Google Scholar
  41. 41.
    Roder C, Chavanne A, Mannion AF, Grob D, Aebi M (2005) SSE Spine Tango-content, workflow, set-up. Eur Spine J 14:920–924. http://www.eurospine.org-SpineTango Google Scholar
  42. 42.
    Roder C, El-Kerdi A, Eggli S, Aebi M (2004) A centralized total joint replacement registry using web-based technologies. J Bone Joint Surg Am 86-A:2077–2079 (discussion 2079–2080)PubMedGoogle Scholar
  43. 43.
    Roder C, El-Kerdi A, Grob D, Aebi M (2002) A European spine registry. Eur Spine J 11:303–307PubMedCrossRefGoogle Scholar
  44. 44.
    Roder C, Staub L, Dietrich D, Zweig T, Melloh M, Aebi M (2009) Benchmarking with Spine Tango: potentials and pitfalls. Eur Spine J. doi: 10.1007/s00586-009-0943-7
  45. 45.
    Rothwell PM (2005) External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet 365:82–93PubMedCrossRefGoogle Scholar
  46. 46.
    Schluessmann E, Diel P, Aghayev E, Zweig T, Moulin P, Roder C (2009) SWISSspine: a nationwide registry for health technology assessment of lumbar disc prostheses. Eur Spine J 18:851–861PubMedCrossRefGoogle Scholar
  47. 47.
    Selkowitz DM, Kulig K, Poppert EM, Flanagan SP, Matthews ND, Beneck GJ, Popovich JM Jr, Lona JR, Yamada KA, Burke WS, Ervin C, Powers CM (2006) The immediate and long-term effects of exercise and patient education on physical, functional, and quality-of-life outcome measures after single-level lumbar microdiscectomy: a randomized controlled trial protocol. BMC Musculoskelet Disord 7:70PubMedCrossRefGoogle Scholar
  48. 48.
    van der Roer N, Ostelo RW, Bekkering GE, van Tulder MW, de Vet HC (2006) Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine 31:578–582PubMedCrossRefGoogle Scholar
  49. 49.
    van Tulder M, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16:761–775PubMedCrossRefGoogle Scholar
  50. 50.
    van Tulder MW, Koes B, Seitsalo S, Malmivaara A (2006) Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J 15:S82–S92 (Epub 2005 Dec 2001)PubMedCrossRefGoogle Scholar
  51. 51.
    van Tulder MW, Tuut M, Pennick V, Bombardier C, Assendelft WJ (2004) Quality of primary care guidelines for acute low back pain. Spine 29:E357–E362PubMedCrossRefGoogle Scholar
  52. 52.
    Zweig T, Mannion AF, Grob D, Melloh M, Munting E, Tuschel A, Aebi M, Roder C (2009) How to Tango: a manual for implementing Spine Tango. Eur Spine J 18(Suppl 3):312–320. doi: 10.1007/s00586-009-1074-x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • J. T. Kessler
    • 1
  • M. Melloh
    • 2
  • Thomas Zweig
    • 3
  • E. Aghayev
    • 3
  • C. Röder
    • 3
  1. 1.Center for Osteopathy ZürichZurichSwitzerland
  2. 2.Section of Orthopaedic Surgery, Department of Medical and Surgical Sciences, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  3. 3.MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopaedic SurgeryUniversity of BerneBernSwitzerland

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