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Title: The development of a primary care interdisciplinary guideline for the clinical management of low back pain: the “CLIP” project.

Authors and affiliation: Stéphane Poitras and Michel Rossignol (McGill University and Direction de la santé publique de Montréal); Bertrand Arsenault (Université de Montréal); Clermont Dionne and Manon Truchon (Université Laval); Michel Tousignant and Patrick Loisel (Université de Sherbrooke); Diane Berthelette (Université du Québec à Montréal); Pierre Allard (Jewish general hospital).

Email address: stephane.poitras@mcgill.ca

Introduction: A 2004 review on the quality of primary care guidelines for low back pain concluded that the methodological quality, using the AGREE criteria, of reporting of most published guidelines was low.  There also appears to be a lack of guidelines aimed at enhancing communication and collaboration amongst primary care health professionals in the management of low back pain.   

Objective: To develop a primary care guideline for the clinical management of low back pain using the AGREE criteria as a basis for its development, with a focus on interdisciplinary management. 

Methods: An eight-member project team, composed of physician, physiotherapist and occupational therapist clinicians and health researchers, was constituted with the objective of developing recommendations for the clinical management of low back pain based on existing guidelines, systematic reviews and meta-analyses.  The quality of these reviews was assessed by the project team with the Oxman checklist.  Management recommendations were then submitted, using web based tools, for comments on clarity, interpretation and usability to: representatives of relevant health professional colleges and clinician associations; a convenience sample of 184 physician, physiotherapist and occupational therapist clinicians; and a seven-member independent scientific committee composed of physician, physiotherapist, occupational therapist and community care researchers.  Following these comments, management recommendations were revised.  With these recommendations, a nine-member team consisting of physician, physiotherapist and occupational therapist opinion leaders was constituted with the aim of developing an interdisciplinary clinical management algorithm.  The project team and scientific committee members reviewed this algorithm to assure it was representative of the clinical management recommendations. 

Results:  Clinical management recommendations for low back pain were organized into three modules: evaluation, treatment, and management of long-term disability, each module composed of five, four and three management recommendations respectively.  Through the website, 177 comments were posted and 101 forms completed by the clinician sample.  A guideline composed of the revised clinical management recommendations and the treatment algorithm was then proposed to the health professional colleges and clinician associations for distribution to their members.