title: A proposed set of metrics for standardized outcome reporting in the management of low back pain.
abstract: OBJECTIVE
  Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set.
  
  
  METHODS
  An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions.
  
  
  RESULTS
  Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools.
  
  
  CONCLUSIONS
  The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.
authors.affiliation: a 1 Department of Orthopaedic Surgery, University of North Carolina Hospitals , Chapel Hill, NC, USA.
authors.forename: R Carter
authors.initials: RC
authors.lastname: Clement
authors.affiliation: b 2 Boston Consulting Group , Stockholm, Sweden.
authors.forename: Adina
authors.initials: A
authors.lastname: Welander
authors.affiliation: c 3 International Consortium for Health Outcomes Measurement , Boston, MA, USA.
authors.forename: Caleb
authors.initials: C
authors.lastname: Stowell
authors.affiliation: d 4 Department of Orthopaedics, Massachusetts General Hospital , Boston, MA, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Cha
authors.affiliation: e 5 Department of Orthopaedic Surgery , Singapore General Hospital, Singapore.
authors.forename: John L
authors.initials: JL
authors.lastname: Chen
authors.affiliation: f 6 Patient representative , Brisbane, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Davies
authors.affiliation: g 7 Nuffield Orthopaedic Centre, University of Oxford , Oxford, UK.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Fairbank
authors.affiliation: h 8 Department of Neurosurgery, University of Tennessee Health Science Center , Memphis, TN, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Foley
authors.affiliation: i 9 Department of Orthopaedic Surgery, Spine Section, Rigshospitalet, University Hospital of Copenhagen , Copenhagen, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Gehrchen
authors.affiliation: j 10 Spine Center Göteborg , Gothenburg, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Hagg
authors.affiliation: k 11 Department of Neurosurgery, Leiden University Medical Center , Leiden, the Netherlands.
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Jacobs
authors.affiliation: l 12 BrizBrain and Spine , Brisbane, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Kahler
authors.affiliation: m 13 Department of Orthopaedics, Division of Spine, Ohio State University , Wexner Medical Center, Columbus, OH, USA.
authors.forename: Safdar N
authors.initials: SN
authors.lastname: Khan
authors.affiliation: n 14 Texas Back Institute , Plano, TX, USA.
authors.forename: Isador H
authors.initials: IH
authors.lastname: Lieberman
authors.affiliation: o 15 Newro Foundation , Brisbane, Australia.
authors.forename: Beth
authors.initials: B
authors.lastname: Morisson
authors.affiliation: n 14 Texas Back Institute , Plano, TX, USA.
authors.forename: Donna D
authors.initials: DD
authors.lastname: Ohnmeiss
authors.affiliation: p 16 Department of Neurosurgery, Leiden University Medical Center and Medical Center Haaglanden , Leiden and The Hague, the Netherlands.
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
authors.affiliation: q 17 Director, Spine SCOAP Collaborative, Rainier Orthopedic Institute , Puyallup, WA, US.
authors.forename: Neal H
authors.initials: NH
authors.lastname: Shonnard
authors.affiliation: r 18 Department of Orthopaedic Surgery, PM&R Section, Stanford University , Palo Alto, CA, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Smuck
authors.affiliation: s 19 Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway , Tromsø, Norway.|t 20 The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority , Tromsø, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Solberg
authors.affiliation: u 21 Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital , Lund, Sweden.
authors.forename: Bjorn H
authors.initials: BH
authors.lastname: Stromqvist
authors.affiliation: v 22 Sint Maartenskliniek, Research , Nijmegen, the Netherlands.
authors.forename: Miranda L Van
authors.initials: ML
authors.lastname: Hooff
authors.affiliation: w 23 Department of Anesthesiology , University of Pittsburgh Medical Center Pittsburgh, PA, USA.
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.affiliation: x 24 Maastricht University Medical Center , Maastricht, the Netherlands.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Willems
authors.affiliation: y 25 Orthopaedic Diagnostic Centre , Singapore General Hospital, Singapore.
authors.forename: William
authors.initials: W
authors.lastname: Yeo
authors.affiliation: z 26 Department of Orthopaedic Surgery, Ryhov Hospital , Jönköping, Sweden.|aa 27 Registry Manager , Swespine.
authors.forename: Peter
authors.initials: P
authors.lastname: Fritzell
mesh_terms: D003697:Delphi Technique; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D012307:Risk Factors; D016896:Treatment Outcome
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