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The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities

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Abstract

Purpose

The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources.

Methods

We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation-II criteria. Low risk of bias clinical practice guidelines was used to develop recommendations. In accordance with the mandate of the Global Spinal Care Initiative (GSCI), recommendations were selected that could be applied to medically underserved areas and low- and middle-income countries by considering the limited access and costs of diagnostic technologies.

Results

We screened 3069 citations; 20 guidelines were eligible for critical appraisal. We used 13 that had a low risk of bias that targeted neck and back pain.

Conclusions

When assessing patients with spine-related complaints in medically underserved areas and low- and middle-income countries, we recommend that clinicians should: (1) take a clinical history to determine signs or symptoms suggesting serious pathology (red flags) and psychological factors (yellow flags); (2) perform a physical examination (musculoskeletal and neurological); (3) do not routinely obtain diagnostic imaging; (4) obtain diagnostic imaging and/or laboratory tests when serious pathologies are suspected, and/or presence of progressive neurologic deficits, and/or disabling persistent pain; (5) do not perform electromyography or nerve conduction studies for diagnosis of intervertebral disc disease with radiculopathy; and (6) do not perform discography for the assessment of spinal disorders. This information can be used to inform the GSCI care pathway and model of care.

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Fig. 1
Fig. 2

Adapted from Acute Low Back Problems in Adults: Assessment and Treatment [53] and PROMIS Pain Interference questionnaire [54]

Fig. 3

Adapted from Report of the NIH Task Force on research standards for chronic low back pain and the New Zealand Acute Low Back Pain Guide [62,63,64]; Patient Health Questionnaire (PHQ-4) [65]; and Oswestry Disability Index [59]

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Acknowledgements

We thank Leslie Verville and Geoff Outerbridge for their contributions to this paper.

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.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, New York University, New York, NY, USA

    Margareta Nordin

  2. Department of Environmental Medicine, New York University, New York, NY, USA

    Margareta Nordin

  3. World Spine Care Europe, Holmfirth, UK

    Margareta Nordin

  4. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada

    Kristi Randhawa, Hainan Yu & Pierre Côté

  5. UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada

    Kristi Randhawa, Hainan Yu, Pierre Côté & Anne Taylor-Vaisey

  6. Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile

    Paola Torres

  7. Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA

    Scott Haldeman

  8. Department of Neurology, University of California, Irvine, Irvine, CA, USA

    Scott Haldeman

  9. World Spine Care, Santa Ana, CA, USA

    Scott Haldeman

  10. World Spine Care, Tampa, FL, USA

    O’Dane Brady

  11. Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Carlos Torres

  12. Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Michael Modic

  13. University Department of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India

    Rajani Mullerpatan

  14. Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland

    Christine Cedraschi

  15. Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland

    Christine Cedraschi

  16. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA

    Roger Chou

  17. Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Roger Chou

  18. ARTES Spine Center, Ankara, Turkey

    Emre Acaroğlu

  19. Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI, USA

    Eric L. Hurwitz

  20. Institut Franco-Européen de Chiropraxie, Toulouse, France

    Nadège Lemeunier

  21. Department of Rheumatology, HFR Fribourg, Hospital Cantonal, Fribourg, FR, Switzerland

    Jean Dudler

  22. Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey

    Erkin Sönmez

Authors
  1. Margareta Nordin
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  2. Kristi Randhawa
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  3. Paola Torres
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  4. Hainan Yu
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  5. Scott Haldeman
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  6. O’Dane Brady
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  7. Pierre Côté
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  8. Carlos Torres
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  9. Michael Modic
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  10. Rajani Mullerpatan
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  11. Christine Cedraschi
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  12. Roger Chou
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  13. Emre Acaroğlu
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  14. Eric L. Hurwitz
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  15. Nadège Lemeunier
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  16. Jean Dudler
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  17. Anne Taylor-Vaisey
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  18. Erkin Sönmez
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Corresponding author

Correspondence to Margareta Nordin.

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Conflict of interest

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. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. PT declares no COI. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. 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. OB declares he is a consultant for: Pacira Pharmaceuticals, Inc. Palladian Health. Travel expenses: World Spine Care. Stipend: World Spine Care. 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. CT declares no COI. MM declares no COI. RM declares no COI. CC declares no COI. RC declares funding from AHRQ to conduct systematic reviews on treatments for low back pain within last 2 years. Honoraria for speaking at numerous meetings of professional societies and non-profit groups on topics related to low back pain (no industry sponsored talks). EAc declares grants: Depuy Synthes Spine, Medtronic; Speaker’s bureau: AOSpine, Zimmer Biomet. 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. NL declares no COI. JD declares no COI. ATV declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. ES declares funding from Başkent University Research Fund.

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Nordin, M., Randhawa, K., Torres, P. et al. The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities. Eur Spine J 27 (Suppl 6), 816–827 (2018). https://doi.org/10.1007/s00586-017-5446-3

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