The Spine Team Assessment for chronic back pain disability. Part 2: team decision making and a preliminary outcome study.
OBJECTIVE
Back pain disability is complex, involving medical, physical, functional, social, and financial issues. This study aims to develop the first codified decision making process for individualized treatment planning.


METHODS
In a multidisciplinary assessment protocol for chronic low back pain disability, the Spine Team Assessment (see Part I), a 'case law' qualitative approach to decision making began with a basic framework. Details were established over 103 cases at a community hospital. Through 500 more cases, a university spine program developed new exceptions, definitions, and rule clarifications.


RESULTS
The final framework includes physical deconditioning, psychosocial factors, and potential for cure, with dozens of subcategories. Seventeen different combinations of therapy were recommended. Of 68 persons referred to one multidisciplinary treatment protocol, at 6 - 12 months the 17 completers had less work disability (31 vs. 62%, p = 0.032) and tended towards fewer subsequent diagnostic tests (17.6 vs. 34.7%) and less surgery (0 vs. 4).


CONCLUSIONS
The data suggests that the process is complex, that customization did occur, and that at least one team decision led to better outcomes. While derived qualitatively, this decision-making tree provides a road map for less experienced teams and a precedent for researchers who wish to study individualized treatment.
Haig
Andrew J
AJ
Departments of Physical Medicine, The Spine Program, University of Michigan, Ann Arbor, MI 48108, USA. Andyhaig@umich.edu
Geisser
Michael E
ME
Michel
Britt
B
Theisen-Goodvich
Mary
M
Yamakawa
Karen
K
Buchholz
Rodney
R
Burke
John
J
Lamphiear
Ruth
R
Legatski
Kathy
K
Smith
Carol
C
Sacksteder
Joan
J
D000328:Adult; D001416:Back Pain / Q000523:psychology / Q000534:rehabilitation*; D002908:Chronic Disease; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D010348:Patient Care Team; D011795:Surveys and Questionnaires