Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

Cathriona Murphy; Helen French; Geraldine McCarthy; Caitriona Cunningham

doi:10.1007/s00586-022-07180-4

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

Eur Spine J. 2022 Jul;31(7):1846-1865. doi: 10.1007/s00586-022-07180-4. Epub 2022 Apr 5.

Authors

Cathriona Murphy¹, Helen French², Geraldine McCarthy³, Caitriona Cunningham⁴

Affiliations

¹ Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. caitriona.murphy1@ucdconnect.ie.
² School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
³ Clinical Professor of Medicine, University College Dublin and Consultant Rheumatologist, Mater Misericordiae University Hospital, Dublin, Ireland.
⁴ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.

PMID: 35378631
DOI: 10.1007/s00586-022-07180-4

Abstract

Purpose: Clinical pathways for low back pain (LBP) have potential to improve clinical outcomes and health service efficiency. This systematic review aimed to synthesise the evidence for clinical pathways for LBP and/or radicular leg pain from primary to specialised care and to describe key pathway components.

Methods: Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) from 2006 onwards were conducted with further manual and citation searching. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal. A narrative synthesis of findings is presented.

Results: From 18,443 identified studies, 28 papers met inclusion criteria. Pathways were developed primarily to address over-burdened secondary care services in high-income countries and almost universally used interface services with a triage remit at the primary-secondary care boundary. Accordingly, evaluation of healthcare resource use and patient flow predominated, with interface services associated with enhanced service efficiency through decreased wait times and appropriate use of consultant appointments. Low quality study designs, heterogeneous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical- and cost-effectiveness. Pathways demonstrated basic levels of care integration across the primary-secondary care boundary.

Conclusions: The limited volume of research evaluating clinical pathways for LBP/radicular leg pain and spanning primary and specialised care predominantly used interface services to ensure appropriate specialised care referrals with associated increased efficiency of care delivery. Pathways demonstrated basic levels of care integration across healthcare boundaries. Well-designed randomised controlled trials to explore the potential of clinical pathways to improve clinical outcomes, deliver cost-effective, guideline-concordant care and enhance care integration are required.

Keywords: Back pain; Clinical pathway; Integrated care; Radicular leg pain; Systematic review.

Publication types

Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Critical Pathways*
Humans
Low Back Pain* / diagnosis
Low Back Pain* / therapy
Referral and Consultation