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


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

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Publication Title

European Spine Journal




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.




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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