International comparative study of low back pain care pathways and analysis of key interventions

E. Coeckelberghs, H. Verbeke, A. Desomer, P. Jonckheer, D. Fourney, P. Willems, M. Coppes, R. Rampersaud, M. van Hooff, E. van den Eede, G. Kulik, P. de Goumoens, K. Vanhaecht, B. Depreitere*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Web of Science)


Purpose Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain.Methods International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements.Results Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures.Conclusion Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
Original languageEnglish
Pages (from-to)1043-1052
Number of pages10
JournalEuropean Spine Journal
Issue number4
Early online date11 Jan 2021
Publication statusPublished - Apr 2021


  • burden
  • care pathway
  • clinical-course
  • expenditures
  • guidelines
  • hospital care
  • low back pain
  • management
  • model
  • multidisciplinary
  • multidisciplinary work
  • patient reported outcome measures
  • primary care
  • radicular pain
  • spine surgery referrals
  • triage
  • Patient reported outcome measures
  • Low back pain
  • Hospital care
  • Multidisciplinary work
  • Triage
  • Care pathway
  • Primary care
  • Radicular pain

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