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Open Access Highly Accessed Correspondence

Integrative care for the management of low back pain: use of a clinical care pathway

Michele J Maiers*, Kristine K Westrom, Claire G Legendre and Gert Bronfort

Author Affiliations

Northwestern Health Sciences University, 2501 W 84th St Bloomington, MN 55431, USA

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BMC Health Services Research 2010, 10:298  doi:10.1186/1472-6963-10-298

Published: 29 October 2010

Abstract

Background

For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial.

Methods

A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study.

Results

Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans.

Conclusion

This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting.

Trial registration

ClinicalTrials.gov NCT00567333