An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project.
BACKGROUND
Low-back pain is responsible for significant disability and costs in industrialized countries. Only a minority of subjects suffering from low-back pain will develop persistent disability. However, this minority is responsible for the majority of costs and has the poorest health outcomes. The objective of the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) project was to develop a primary care interdisciplinary practice model for the clinical management of low-back pain and the prevention of persistent disability.


METHODS
Using previously published guidelines, systematic reviews and meta-analyses, a clinical management model for low-back pain was developed by the project team. A structured process facilitating discussions on this model among researchers, stakeholders and clinicians was created. The model was revised following these exchanges, without deviating from the evidence.


RESULTS
A model consisting of nine elements on clinical management of low-back pain and prevention of persistent disability was developed. The model's two core elements for the prevention of persistent disability are the following: 1) the evaluation of the prognosis at the fourth week of disability, and of key modifiable barriers to return to usual activities if the prognosis is unfavourable; 2) the evaluation of the patient's perceived disability every four weeks, with the evaluation and management of barriers to return to usual activities if perceived disability has not sufficiently improved.


CONCLUSIONS
A primary care interdisciplinary model aimed at improving quality and continuity of care for patients with low-back pain was developed. The effectiveness, efficiency and applicability of the CLIP model in preventing persistent disability in patients suffering from low-back pain should be assessed.
Poitras
Stéphane
S
Montreal Department of Public Health, McGill University, Montreal, Canada. stephane.poitras@uottawa.ca
Rossignol
Michel
M
Dionne
Clermont
C
Tousignant
Michel
M
Truchon
Manon
M
Arsenault
Bertrand
B
Allard
Pierre
P
Coté
Manon
M
Neveu
Alain
A
D019468:Disease Management; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D008962:Models, Theoretical; D010147:Pain Measurement / Q000379:methods / Q000639:trends; D010348:Patient Care Team / Q000639:trends; D011320:Primary Health Care / Q000379:methods* / Q000639:trends