A proposed set of metrics for standardized outcome reporting in the management of low back pain

R. Carter Clement, Adina Welander, Caleb Stowell, Thomas D. Cha, John L. Chen, Michelle Davies, Jeremy C. Fairbank, Kevin Foley, Martin Gehrchen, Olle Hagg, Wilco C. Jacobs, Richard Kahler, Safdar N. Khan, Isador H. Lieberman, Beth Morisson, Donna D. Ohnmeiss, Wilco C. Peul, Neal H. Shonnard, Matthew W. Smuck, Tore K. Solberg & 6 others Bjorn H. Stromqvist, Miranda L.Van Hooff, Ajay D. Wasan, Paul C. Willems, William Yeo, Peter Fritzell

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

Background and purpose-Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set.Patients and methods-An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions.Results-Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools.Interpretation-The outcome measures recommended here are structured around specific etiologies of LBP, span a patients entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.

Original languageEnglish (US)
Pages (from-to)523-533
Number of pages11
JournalActa Orthopaedica
Volume86
Issue number5
DOIs
StatePublished - Sep 3 2015

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Low Back Pain
Outcome Assessment (Health Care)
Delivery of Health Care
Risk Adjustment
Quality of Health Care
Analgesics
Spine
Quality of Life
Pain
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Clement, R. C., Welander, A., Stowell, C., Cha, T. D., Chen, J. L., Davies, M., ... Fritzell, P. (2015). A proposed set of metrics for standardized outcome reporting in the management of low back pain. Acta Orthopaedica, 86(5), 523-533. https://doi.org/10.3109/17453674.2015.1036696

A proposed set of metrics for standardized outcome reporting in the management of low back pain. / Clement, R. Carter; Welander, Adina; Stowell, Caleb; Cha, Thomas D.; Chen, John L.; Davies, Michelle; Fairbank, Jeremy C.; Foley, Kevin; Gehrchen, Martin; Hagg, Olle; Jacobs, Wilco C.; Kahler, Richard; Khan, Safdar N.; Lieberman, Isador H.; Morisson, Beth; Ohnmeiss, Donna D.; Peul, Wilco C.; Shonnard, Neal H.; Smuck, Matthew W.; Solberg, Tore K.; Stromqvist, Bjorn H.; Hooff, Miranda L.Van; Wasan, Ajay D.; Willems, Paul C.; Yeo, William; Fritzell, Peter.

In: Acta Orthopaedica, Vol. 86, No. 5, 03.09.2015, p. 523-533.

Research output: Contribution to journalReview article

Clement, RC, Welander, A, Stowell, C, Cha, TD, Chen, JL, Davies, M, Fairbank, JC, Foley, K, Gehrchen, M, Hagg, O, Jacobs, WC, Kahler, R, Khan, SN, Lieberman, IH, Morisson, B, Ohnmeiss, DD, Peul, WC, Shonnard, NH, Smuck, MW, Solberg, TK, Stromqvist, BH, Hooff, MLV, Wasan, AD, Willems, PC, Yeo, W & Fritzell, P 2015, 'A proposed set of metrics for standardized outcome reporting in the management of low back pain', Acta Orthopaedica, vol. 86, no. 5, pp. 523-533. https://doi.org/10.3109/17453674.2015.1036696
Clement, R. Carter ; Welander, Adina ; Stowell, Caleb ; Cha, Thomas D. ; Chen, John L. ; Davies, Michelle ; Fairbank, Jeremy C. ; Foley, Kevin ; Gehrchen, Martin ; Hagg, Olle ; Jacobs, Wilco C. ; Kahler, Richard ; Khan, Safdar N. ; Lieberman, Isador H. ; Morisson, Beth ; Ohnmeiss, Donna D. ; Peul, Wilco C. ; Shonnard, Neal H. ; Smuck, Matthew W. ; Solberg, Tore K. ; Stromqvist, Bjorn H. ; Hooff, Miranda L.Van ; Wasan, Ajay D. ; Willems, Paul C. ; Yeo, William ; Fritzell, Peter. / A proposed set of metrics for standardized outcome reporting in the management of low back pain. In: Acta Orthopaedica. 2015 ; Vol. 86, No. 5. pp. 523-533.
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AU - Welander, Adina

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AU - Chen, John L.

AU - Davies, Michelle

AU - Fairbank, Jeremy C.

AU - Foley, Kevin

AU - Gehrchen, Martin

AU - Hagg, Olle

AU - Jacobs, Wilco C.

AU - Kahler, Richard

AU - Khan, Safdar N.

AU - Lieberman, Isador H.

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AU - Peul, Wilco C.

AU - Shonnard, Neal H.

AU - Smuck, Matthew W.

AU - Solberg, Tore K.

AU - Stromqvist, Bjorn H.

AU - Hooff, Miranda L.Van

AU - Wasan, Ajay D.

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AU - Fritzell, Peter

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N2 - Background and purpose-Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set.Patients and methods-An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions.Results-Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools.Interpretation-The outcome measures recommended here are structured around specific etiologies of LBP, span a patients entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.

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