The Global Spine Care Initiative: care pathway for people with spine-related concerns.


Scott Haldeman, University of California, Los Angeles
Claire D Johnson, National University of Health Sciences
Roger Chou, Oregon Health & Science University
Margareta Nordin, New York University
Pierre Côté, University of Ontario Institute of Technology, Oshawa, Canada
Eric L Hurwitz, University of Hawaii, Manoa
Bart N Green, National University of Health Sciences
Christine Cedraschi, Geneva University Hospitals
Emre Acaroğlu, ARTES Spine Center, Ankara, Turkey
Deborah Kopansky-Giles, University of Toronto
Arthur Ameis, University of Montreal
Afua Adjei-Kwayisi, Ghana World Spine Care, Accra, Ghana
Selim Ayhan, Acibadem University, Ankara, Turkey
Fiona Blyth, University of Sydney, Australia
David Borenstein, George Washington University
O'Dane Brady, World Spine Care, Tampa, FL
Peter Brooks, University of Melbourne, Australia
Connie Camilleri, St. Michael’s Hospital, North York, ON, Canada
Juan M Castellote, University of Complutense, Madrid
Michael B Clay, Cincinnati Veterans Affairs Medical Center
Fereydoun Davatchi, Tehran University of Medical Sciences, Iran
Robert Dunn, University of Cape Town, South Africa
Christine Goertz, Palmer College of Chiropractic, Davenport, Iowa
Erin A Griffith, Emergency Medicine, Carlsbad, CA
Maria Hondras, University of Kansas Medical Center
Edward J Kane, University of St. Augustine for Health SciencesFollow
Nadège Lemeunier, Institut Franco-Européen de Chiropraxie, Toulouse, France
John Mayer, U.S. Spine & Sport Foundation, San Diego, CA
Tiro Mmopelwa, Life Gaborone Hospital, Gaborone, Botswana
Michael Modic, Lerner College of Medicine, Cleveland, OH
Jean Moss, Canadian Memorial Chiropractic College, Toronto, Canada
Rajani Mullerpatan, Mahatma Gandhi Mission Institute of Health Sciences, Maharashtra, India
Elijah Muteti, Moi University, Eldoret, Kenya
Lillian Mwaniki, Law Society of Kenya
Madeleine Ngandeu-Singwe, University of Yaoundé I, Cameroon
Geoff Outerbridge, Canadian Memorial Chiropractic College, Chelsea, QC
Kristi Randhawa, University of Ontario Institute of Technology, Oshawa, Canada
Heather Shearer, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
Erkin Sönmez, Başkent University School of Medicine, Ankara, Turkey
Carlos Torres, University of Ottawa, Ottawa, ON, Canada
Paola Torres, Universidad Finis Terrae, Santiago, Chile
Leslie Verville, University of Ontario Institute of Technology, Oshawa, Canada
Adriaan Vlok, University of Stellenbosch, Bellville, Western Cape, South Africa
William Watters, University of Texas Medical Branch, Galveston, TX
Chung Chek Wong, Sarawak General Hospital, Kuching, Sarawak, Malaysia
Hainan Yu, University of Ontario Institute of Technology, Oshawa, Canada

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European Spine Journal



Medical Subject Headings

Delivery of health care; Evidence-based practice; Quality of health care; Triage


PURPOSE: The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally.

METHODS: The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used.

RESULTS: After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records.

CONCLUSION: A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.




Suppl 6

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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Cedraschi C, Acaroğlu E, Kopansky-Giles D, Ameis A, Adjei-Kwayisi A, Ayhan S, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dunn R, Goertz C, Griffith EA, Hondras M, Kane EJ, Lemeunier N, Mayer J, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Shearer H, Sönmez E, Torres C, Torres P, Verville L, Vlok A, Watters W 3rd, Wong CC, Yu H. The Global Spine Care Initiative: care pathway for people with spine-related concerns. Eur Spine J. 2018 Sep;27(Suppl 6):901-914. https://doi.org/10.1007%2Fs00586-018-5721-y