Quality improvement in neurology (original) (raw)
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Implementation of a Guideline for Low Back Pain Management in Primary Care
Spine, 2012
Study Design. Cost-effectiveness analysis alongside a cluster randomized controlled trial. Objective. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Summary of Background Data. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking.
The Spine Journal, 2011
BACKGROUND CONTEXT: Treatment guidelines suggest that most acute low back pain (LBP) episodes substantially improve within a few weeks and that immediate use of imaging and aggressive therapies should be avoided. PURPOSE: Assess the actual practice patterns of imaging, noninvasive therapy, medication use, and surgery in patients with LBP, and compare their costs to those of matched controls without LBP. STUDY DESIGN: A retrospective analysis of claims data from 40 self-insured employers in the United States. PATIENT SAMPLE: The study sample included 211,551 patients, aged 18 to 64 years, with one LBP diagnosis or more (per Healthcare Effectiveness Data and Information Set specification) during 2004 to 2006, identified from a claims database. Patients had continuous eligibility for 12 months or more after their index LBP diagnosis (study period), for 6 months or more before their index diagnosis (baseline period), and no other LBP diagnosis during the baseline period. Patients with LBP were matched to a random cohort of patients without LBP by age, gender, employment status, and index year. OUTCOMES MEASURES: Physiological measures (eg, imaging and diagnostic tests), functional measures (eg, pharmacologic and nonpharmacologic treatment for LBP, health-care resource use), and direct (medical and prescription drug) and indirect (disability and medically related absenteeism) costs were assessed within the year after the LBP diagnosis. METHODS: Univariate analyses described treatment patterns and compared baseline characteristics and study period costs. RESULTS: Patients with LBP had significantly higher rates of baseline comorbidities and resource use compared with controls. Of patients with LBP, 41.6% had imaging mean median) [standard deviation] 34.3 (0) [78.6] days after the LBP diagnosis. Most patients with LBP (69.4%) used medications starting 51.9 (8) [86.2] days after the diagnosis. Opioids were commonly prescribed early (41.6% of patients; after 82.8 (25) [105.9] days). Of patients with LBP, 2.05% had surgery during the study period. Patients with LBP were likely to have chiropractic treatment first, followed by pharmacotherapy with muscle relaxants and nonsteroidal anti-inflammatory drugs. Except for less
Profile of Low Back Pain Patients at the Neurology Polyclinic
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.12\_Dec2022/IJHSR-Abstract28.html, 2022
Low back pain is a condition that disturbs a person's comfort due to pain that arises between the fifth lumbar and first sacral vertebrae (L5-S1). LBP complaints are the main cause of loss of productive years due to disability due to illness and injury in DKI Jakarta in 2017. Risk factors for LBP are age, gender, obesity, work factors (lifting heavy loads and non-ergonomic posture), exercise habits, and past medical history. This paper discusses the profile of LBP patients at the Neurology Polyclinic of UKI General Hospital from January 2019-December 2020. This study used a descriptive method with a cross-sectional retrospective study design. Data were obtained by collecting and analyzing the medical records of patients at the Neurology Polyclinic of UKI General Hospital who came for treatment with a major complaint of LBP. The number of research samples was determined using the total sampling method. Out of 101 LBP patients who came for treatment at the UKI General Hospital neurology polyclinic in January 2019-December 2002, only 83 patients had complete medical records, so the sample in this study was 83. Most analyses of results based on age, sex, occupation, BMI, type of LBP, duration of LBP, past medical history, most common diagnosis, and treatment obtained by patients, namely: age group >65 years of 27 people (32.5%), sex 55 women (66.3%), 36 housewives (43.4%), BMI category 25-29.9 or obesity I 29 people (34.9%), radicular pain type 49 people (59.0%), LBP 45 people (54.2%) had an acute illness, 51 people (61.4%) had no previous history of the disease, 30 people (36.1%) Lumbar HNP, and conservative management in the form of medication and physiotherapy 81 people (97.6%).
Continuous quality improvement for patients with back pain
Journal of General Internal Medicine, 2000
Recent evidence has changed traditional approaches to low back pain, suggesting minimal bed rest, highly selective imaging, and early return to normal activities. However, there are wide geographical variations in care, and substantial gaps between practice and evidence.
Syddansk Universitet Neurophysiological Pain Education for Patients With Chronic Low Back Pain
2018
Objective: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). Methods: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Results: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD = −1.03 (95% confidence interval [CI], −0.55 to −1.52), and after 3 months, WMD = −1.09 (95% CI, −2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD = −0.47 (95% CI, −0.80 to −0.13) and after 3 months SMD = −0.38 (95% CI, −0.74 to −0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD = −5.73 (95% CI, −13.60 to 2.14) and after 3 months WMD = −0.94 (95% CI, −6.28 to 4.40). Discussion: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.
VA/DoD Clinical Practice Guideline: Diagnosis and Treatment of Low Back Pain
Journal of General Internal Medicine
, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved the joint Clinical Practice Guideline (CPG) for Diagnosis and Management of Low Back Pain. This CPG was intended to provide healthcare providers a framework by which to evaluate, treat, and manage patients with low back pain (LBP). METHODS: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through September 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A patient focus group was also convened to ensure patient values and perspectives were considered when formulating preferences and shared decision making in the guideline. RECOMMENDATIONS: The VA/DOD LBP CPG provides evidence-based recommendations for the diagnostic approach, education and self-care, non-pharmacologic and non-invasive therapy, pharmacologic therapy, dietary supplements, non-surgical invasive therapy, and team approach to treatment of low back pain.
SPINE20 A global advocacy group promoting evidence-based spine care of value
European Spine Journal, 2021
The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. The areas of immediate concern were “Aging spine,” “Future of spine care,” “Spinal cord injuries,” “Children and adolescent spine,” “Spine-related disability,” “Spine Educational Standards,” “Patient saf...