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The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities

  • Bart N. Green
  • Claire D. Johnson
  • Scott Haldeman
  • Edward J. Kane
  • Michael B. Clay
  • Erin A. Griffith
  • Juan M. Castellote
  • Matthew Smuck
  • Shanmuganathan Rajasekaran
  • Eric L. Hurwitz
  • Margareta Nordin
  • Kristi Randhawa
  • Hainan Yu
Original Article

Abstract

Purpose

The purpose of this study was to develop recommendations for prevention interventions for spinal disorders that could be delivered globally, but especially in underserved areas and in low- and middle-income countries.

Methods

We extracted risk factors, associations, and comorbidities of common spinal disorders (e.g., back and neck pain, spinal trauma, infection, developmental disorders) from a scoping review of meta-analyses and systematic reviews of clinical trials, cohort studies, case control studies, and cross-sectional studies. Categories were informed by the Global Spine Care Initiative (GSCI) classification system using the biopsychosocial model. Risk factors were clustered and mapped visually. Potential prevention interventions for individuals and communities were identified.

Results

Forty-one risk factors, 51 associations, and 39 comorbidities were extracted; some were associated with more than one disorder. Interventions were at primary, secondary, tertiary, and quaternary prevention levels. Public health-related actions included screening for osteopenia, avoiding exposure to certain substances associated with spinal disorders, insuring adequate dietary intake for vitamins and minerals, smoking cessation, weight management, injury prevention, adequate physical activity, and avoiding harmful clinical practices (e.g., over-medicalization).

Conclusion

Prevention principles and health promotion strategies were identified that were incorporated in the GSCI care pathway. Interventions should encourage healthy behaviors of individuals and promote public health interventions that are most likely to optimize physical and psychosocial health targeting the unique characteristics of each community. Prevention interventions that are implemented in medically underserved areas should be based upon best evidence, resource availability, and selected through group decision-making processes by individuals and the community.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Health promotion Spinal diseases Risk factors Epidemiology 

Notes

Funding

The Global Spine Care Initiative and this study were funded by Grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.

Compliance with ethical standards

Conflict of interest

BNG receives speaker fees and travel reimbursement from NCMIC Speakers' Bureau; he is secretary of Brighthall Inc; the views in this article are those of the authors and not those of Stanford University, Stanford Health Care, or Qualcomm. CDJ is president of Brighthall Inc; she is an NCMIC Board of Director, however neither she nor NCMIC board make funding decisions for the NCMIC Foundation; the views in this article are those of the authors and not those of Stanford University, Stanford Health Care, or Qualcomm. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stock holder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement—CMCC Board. EJK declares no COI. MBC declares no COI. EAG declares no COI. JMC declares funding from Spanish Government Grant ESPY 112/18. MS declares no COI. SR declares no COI. EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences Data and Safety Monitoring Committee. Chair, Palmer Center for Chiropractic Research. Research Committee Co-chair, World Spine Care. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee. Palladian Health, Clinical Policy Advisory Board member. Book Royalties Wolters Kluwer and Springer. Honoraria for speaking at research method courses. PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care.

Supplementary material

586_2018_5635_MOESM1_ESM.pptx (619 kb)
Supplementary material 1 (PPTX 620 kb)
586_2018_5635_MOESM2_ESM.pdf (57 kb)
Supplementary material 2 (PDF 57 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Qualcomm Health Center, Stanford Health CareSan DiegoUSA
  2. 2.National University of Health SciencesLombardUSA
  3. 3.Department of Epidemiology, School of Public HealthUniversity of California Los AngelesLos AngelesUSA
  4. 4.Department of NeurologyUniversity of California, IrvineIrvineUSA
  5. 5.World Spine CareSanta AnaUSA
  6. 6.College of Rehabilitative Sciences, Doctor of Physical Therapy ProgramUniversity of St. Augustine for Health SciencesSan MarcosUSA
  7. 7.Rehabilitation Care Line, Physical Medicine and RehabilitationCincinnati Veterans Affairs Medical CenterCincinnatiUSA
  8. 8.Emergency MedicineCarlsbadUSA
  9. 9.National School of Occupational MedicineCarlos III Institute of HealthMadridSpain
  10. 10.Physical Medicine and Rehabilitation DepartmentUniversity ComplutenseMadridSpain
  11. 11.Physical Medicine and Rehabilitation Section, Department of Orthopaedic SurgeryStanford UniversityRedwood CityUSA
  12. 12.Department of Orthopaedics and Spine SurgeryGanga HospitalCoimbatoreIndia
  13. 13.Office of Public Health StudiesUniversity of Hawai’i, MānoaHonoluluUSA
  14. 14.Departments of Orthopedic Surgery and Environmental MedicineNew York UniversityNew YorkUSA
  15. 15.World Spine Care EuropeHolmfirthUK
  16. 16.Faculty of Health SciencesUniversity of Ontario Institute of TechnologyOshawaCanada
  17. 17.UOIT-CMCC Centre for Disability Prevention and RehabilitationTorontoCanada

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