Developing low back pain clinical indicators using a new approach.

The STANDING Collaboration is a new approach to develop up-to-date information about the healthcare people should receive.  The project, funded by a National Health and Medical Research Council Program Grant, will focus on a range of common medical conditions, starting with low back pain (LBP).

It is estimated that one in six Australians (approximately 3.7 million people) experience LBP, with most (80%) reporting it limits their daily activity. Several countries, such as the United Kingdom, USA and Denmark, have produced clinical practice guidelines (CPGs) to help guide the management of LBP. Australian guidelines also exist, although they are several years out of date. Despite the availability of these CPGs, people often receive management for LBP that is not evidence-based.

While CPGs serve as a resource for evidence-based care, their practical utility to clinicians is limited (e.g. lack of currency, lengthy documents, vague recommendations which are difficult to measure). CPG development processes are also problematic as they often lack detail of how evidence has been weighted (and conflicts of interest managed) to formulate recommendations, and offer little opportunity for end-users to provide feedback. The STANDING Collaboration will utilise a process that aims to mitigate against these limitations through the use of a wiki. This is an online tool that allows clinicians and consumers to review proposed indicators which have been derived from CPG recommendations, provide feedback, and make edits in real-time, with transparency on how users’ feedback has been incorporated into the final set of indicators. This process will ensure that the indicators guiding care are up-to–date, relevant to all stakeholders, easy to use (written in plain English, one concept at a time) and arranged in a clinical workflow sequence.

Draft clinical indicators for low back pain have been developed and will be available on the STANDING Collaboration wiki for public review soon.