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Eur Spine J. 2018 Sep;27(Suppl 6):816-827. doi: 10.1007/s00586-017-5446-3. Epub 2018 Feb 28.

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.

Author information

1
Department of Orthopedic Surgery, New York University, New York, NY, USA. margareta.nordin@nyu.edu.
2
Department of Environmental Medicine, New York University, New York, NY, USA. margareta.nordin@nyu.edu.
3
World Spine Care Europe, Holmfirth, UK. margareta.nordin@nyu.edu.
4
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.
5
UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada.
6
Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
7
Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
8
Department of Neurology, University of California, Irvine, Irvine, CA, USA.
9
World Spine Care, Santa Ana, CA, USA.
10
World Spine Care, Tampa, FL, USA.
11
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
12
Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA.
13
University Department of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India.
14
Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
15
Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
16
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.
17
Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
18
ARTES Spine Center, Ankara, Turkey.
19
Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI, USA.
20
Institut Franco-Européen de Chiropraxie, Toulouse, France.
21
Department of Rheumatology, HFR Fribourg, Hospital Cantonal, Fribourg, FR, Switzerland.
22
Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey.

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. These slides can be retrieved under Electronic Supplementary Material.

KEYWORDS:

Clinical decision-making; Diagnosis; Review literature as topic; Spine; Symptom assessment

PMID:
29492717
DOI:
10.1007/s00586-017-5446-3

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