Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium -
Belgian Health Care Knowledge Centre, Brussels, Belgium.
Eur J Phys Rehabil Med. 2020 Apr;56(2):228-236. doi: 10.23736/S1973-9087.19.05984-7. Epub 2019 Sep 23.
High level evidence on management of spinal disorders is scarce, which results in guidelines being of limited practical use for practitioners. Care pathways are complex interventions intended for the mutual decision making of organization of care processes for a well-defined group of patients. The goal of this project was to design a pathway for the management of low back pain and radicular pain for national implementation in Belgium.
An international and Belgian study on characteristics of low back pain care pathways was performed along with a literature study and focus group interrogation. Based on essential building elements identified and a consensus approach among all relevant stakeholders in primary, hospital and reintegration care, a national pathway was constructed. The process was endorsed by the Belgian Health Care Knowledge Center, Belgian National Institute of Health and Disability Insurance and the Spine Society of Belgium.
Eleven international pathways were identified, varying in implementation width from hospital-based to region/province-based. Seven Belgian pathway initiatives were detected. Notwithstanding differences, consistent building elements were identified. Three groups of caregivers, divided in primary care, hospital care and reintegration and including all relevant medical/paramedical disciplines, worked on integrating the essential building elements into a single concrete patient pathway of direct use to any caregiver and patient and based on a consensus model including reference to the 2017 Belgian adaptation of the 2016 NICE guidelines. The resulting pathways on management of low back pain and radicular pain underpin the importance of multidisciplinary teamwork.
Essential building elements were identified from literature and established pathways and were successfully integrated in a Belgian national low back pain and radicular pain pathway using an integrative consensus approach. The pathways are consultable at www.lowbackpain.kce.be.
关于脊柱疾病管理的高水平证据很少，这导致指南对从业者的实际应用有限。护理途径是复杂的干预措施，旨在为明确界定的患者群体的护理流程组织进行共同决策。该项目的目标是为管理下腰痛和神经根痛设计一条途径，以便在比利时全国实施。
对国际和比利时的下腰痛护理途径特征进行了研究，同时进行了文献研究和焦点小组询问。根据确定的基本构建要素以及初级、医院和再融合护理中所有相关利益相关者之间的共识方法，构建了一条国家途径。该过程得到了比利时医疗保健知识中心、比利时国家健康和残疾保险研究所和比利时脊柱学会的认可。
确定了 11 条国际途径，实施范围从基于医院到基于区域/省。发现了 7 个比利时途径倡议。尽管存在差异，但仍确定了一致的构建要素。三个护理人员组，分为初级保健、医院护理和再融合，包括所有相关的医学/辅助医学学科，致力于将基本构建要素整合到一个单一的具体患者途径中，该途径可直接用于任何护理人员和患者，并基于共识模型，包括参考 2017 年比利时对 2016 年 NICE 指南的改编。由此产生的下腰痛和神经根痛管理途径强调了多学科团队合作的重要性。
从文献和已建立的途径中确定了基本的构建要素，并使用综合共识方法成功地将其整合到比利时国家下腰痛和神经根痛途径中。这些途径可在 www.lowbackpain.kce.be 查阅。
