About the Workshops

Wednesday 16th March

1.6.1 International consensus, refinement and validation of the new measure of burden of back pain questionnaire (BP-Quest)

The workshop facilitators are Rachelle Buchbinder, Richard H. Osborne, Clermont E. Dionne, Emma Irvin, Roy Batterham

Modern questionnaire design involves many steps and careful attention to both how the respondent understands the question and who will be the user of the data (clinician, service provider, researcher, policy maker). Based upon data collected in a well attended workshop at the last Forum and directly from patients we produced a model of the burden of back pain. This model is guiding the development of a new measure that will comprehensively quantify the burden of back pain from the patient's perspective in a single measure. Prior to the workshop we will send out the draft questionnaire items and constructs for feedback. It is particularly important that we get feedback from many different countries and different settings. We will then pre-test the draft questionnaire items by performing formal cognitive interviews with 10 to 15 people with experience of back pain to verify fidelity between what we need to asking and what they understand the question is asking. At the workshop we will present the draft structure of the BP-Quest and 'workshop' plans for its validation through collaboration between workshop participants who will be asked to field test the draft items. We will also set priorities for future clinical and epidemiological research that could be performed based upon the BP-Quest to inform practice and policy. A manuscript describing the BP-Quest and its development will be prepared for publication and circulated to workshop participants for comments.

1.6.2 Walking programmes for low back pain – Translating the evidence into clinical practice

The workshop facilitators are Deirdre Hurley, Suzanne McDonough, Mark Tully, David Baxter, Paul Hendrick, Meredith Perry, Chris Lonsdale

The use of brief/minimal contact self-activation interventions that encourage participation in physical activity for chronic low back pain (CLBP) is a research priority area. Working with international experts in physical activity measurement and promotion in sedentary populations and incorporating the evidence for cognitive behavioural elements from low back pain research this international research collaboration has devised tailored walking programmes for patients with chronic low back pain that are currently being evaluated in three randomized controlled trials in a range of primary care settings in the Republic of Ireland and Northern Ireland. The walking intervention includes the use of devices to motivate (pedometers) and measure (accelerometers) physical activity. This workshop will present an update on their work supported by pre-reading from recent publications. The focus will be on the translation of the evidence for walking for low back pain into clinical practice. It will present practical guidance on the design and implementation of a walking programme in primary care, including evidence from a qualitative study of trial participants' perceived barriers and enablers to adherence to such a programme. The workshop will also discuss lessons learnt and future research directions.

1.6.3 Upskilling primary care clinicians to integrate psychosocial factors into their management of low back pain patients: where are we now and where next?

The workshop facilitators are Gail Sowden, Jonathan Hill, Chris Main, Nadine Foster

Several recent trials have developed and tested clinical training programmes or courses aimed at upskilling primary care clinicians to integrate the assessment and management of psychosocial factors in their treatment of low back pain. However, we do not know what aspects of these training programmes work best or how best to evaluate their impact. Workshop participants will be invited to contribute to, discuss and debate a series of structured questions in 3 to 4 small groups. They will be asked to make recommendations for the future content, characteristics and evaluation of clinical training programmes aimed at integrating psychosocial factors into LBP management.
Prior to the workshop, a synthesis table will be developed by researchers who have been involved in developing, delivering and evaluating relevant clinical training programmes. The table will provide summary information about the aims, objectives and learning outcomes of the training courses and, if known, the desired competencies. It will also include reflections on what the researchers consider to have been effective/ineffective approaches and the reasons for these. The synthesis table will be sent to all interested participants prior to the workshop.
The synthesis table and workshop discussion and recommendations will form the basis of a paper for publication.

1.6.4 Economic evaluation in low back pain

The workshop facilitators are Maurits van Tulder, Christine Lin

Conducting economic evaluation or cost-effectiveness analysis alongside clinical trials has been recognised as a research priority in musculoskeletal research (Foster et al 2009). Economic evaluation can provide data on treatment efficiency which can guide the allocation of healthcare resources. However, only a small proportion of clinical trials in low back pain incorporate economic evaluation.

This workshop will include presentations to review the findings and limitations of current economic evaluations in low back pain research, and how these findings are used to inform policy and practice. A group discussion will follow to discuss the advantages and limitations of using economic evaluation to inform practice in low back pain research.

1.6.5 Diagnostic research in a condition without a diagnosis: the use of novel approaches in the classification of back pain in primary care

The workshop facilitators are Danielle Van Der Windt, Kate Dunn, Jan Hartvigsen, Raymond Ostelo

In classical diagnostic research the performance of (a set of) symptoms, signs or tests is compared to a reference test ('gold' standard) to classify patients based on the underlying target condition. This classical approach has met with difficulties in back pain research. Back pain is often a multifactorial problem, adequate reference tests are not available, and the probability of a serious underlying medical condition is low. Over the past decade alternative approaches to diagnostic research have been proposed that take into account the absence of optimal reference tests. Examples include: latent class analysis, decision trees, or other statistical approaches not requiring reference tests; the use of expert opinion or clinical judgment as an alternative reference test; using referral or treatment decisions as a reference test, or the use of short-term response to treatment. During the workshop the validity and applicability of these alternative approaches to diagnostic research in back pain will be explored, facilitated by examples from various medical fields. We will discuss to what extent these methods help to produce diagnostic information that may facilitate the classification and management of back pain in primary care. The overall aim is to produce recommendations for the design of novel diagnostic research into the classification of back pain in primary care.

Thursday 17th March

2.5.2 Junior Researchers' Network Workshop

Be part of the start of something innovative and new! The organizers of this meeting are interested in establishing a global network of junior researchers (doctoral students and postdocs) to facilitate development of collaborative links, encourage exchange and provide support for early career researchers. This opportunity for unrestrained discussion and debate will also explore fresh perspectives on issues in research today and into the future. Those interested in attending will be contacted prior to the LBP Forum XI and invited to contribute their initial thoughts by email or on our blog which will inform an agenda for the meeting. A social activity in Melbourne will also be planned for those interested in continuing and extending the networking and discussion.

2.6.1 Back pain mass media campaigns: Next Steps?

The workshop facilitators are Douglas Gross, Erik Werner, Michiel Reneman, Jill Hayden, Rachelle Buchbinder

Mass media campaigns designed to alter societal views about back pain have been evaluated in various countries. The aims of this workshop will be to: 1) identify key differences between previous campaigns that potentially lead to different levels of effectiveness; 2) discuss whether future campaigns will be feasible and effective within the current social context; and if so: 3) set priorities for future research in this area (including key messages and messaging strategies required).

2.6.3 'Fatal flaws' in randomised controlled trials of interventions for low back pain

The workshop facilitators are Nicholas Henschke, Raymond Ostelo, Maurits van Tulder

The pre-specification of clear criteria for including or excluding studies is one of the distinguishing features of a systematic review. However, it is usually only after a decision has been made regarding the eligibility of a study that methodological flaws are evaluated. It is possible, then, that a study could be included in a systematic review even if it has a methodological flaw which is serious enough to render the results implausible (i.e. a "fatal flaw"). The aim of this workshop is to identify which features of RCTs on interventions for low-back pain should be considered "fatal flaws" and to develop recommendations for dealing with them. Prior to the Forum, workshop participants will be asked to complete two survey rounds evaluating a number of potential "fatal flaws" in RCTs. The results of these surveys will be discussed in the workshop and a final consensus-building procedure will be performed.

2.6.3 How are we doing? A critical look at the use of 'global perceived effect' instruments in back pain research

The workshop facilitators are Roni Evans, Jan Hartvigsen, Michele Maiers

Global perceived effect (GPE) is a commonly advocated method in both research and practice for measuring low back pain (LBP) patients'
assessment of their condition. There are several underlying assumptions related to the GPE. The extent to which these assumptions are true, and the methodological challenges associated with using the GPE, warrant critical assessment and debate. Prior to the workshop, attendees will be provided with 2-3 background articles relevant to the workshop topic. At the start of the workshop session, quantitative and qualitative research regarding what is known about the underlying assumptions and challenges in using the GPE will be briefly summarized . This will be followed by facilitated group discussions using a modified World Cafe format exploring the following questions: 1) Should the GPE be used as an external criterion for psychometric testing and determining minimal clinical important change? 2) Is the GPE an appropriate primary outcome measure for LBP trials? 3) Is the GPE a good clinical practice tool for use in individual LBP patients? 4) Which GPE scale should be used? 5) What are the next steps in GPE related research?

2.6.4 Is it time to move beyond MCID?

The workshop facilitators are Michele C. Battié , Rick Deyo

Minimal Clinically Important Difference (MCID) and its determination have been controversial and recurring topics at the Forum. Critics of MCID have argued that while it is a clear advance over merely considering a statistically significant difference, failure to take into account intervention costs, risks and inconveniences in its determination is a serious limitation. Such limitations of MCID have motivated the development of alternative methodologies such as Sufficiently Important Difference (Barrett et al, 2005) and Minimum Acceptable Outcome (Carragee et al 2010). These approaches identify the fraction of subjects achieving a pre-defined level of "success", rather than simply reporting differences in mean scores, and may combine multiple dimensions of outcome to define success. They are patient-centered, incorporate a range of treatment-related considerations, and present opportunities for patient and provider education and informed, shared, clinical decision-making. Their use also has implications for research and health care policy. In considering the question, 'Is it time to move beyond MCID and adopt alternative approaches for LBP research and clinical decision-making?', participants will become familiar with select alternatives and will explore their pros and cons from clinical, research and health care policy perspectives. The workshop will include a brief overview, followed by group discussion to tackle specific core questions and issues.

2.6.5 Understanding the burden of back complaints in older people

The workshop facilitators are Manuela Ferreira; Bart Koes, Chris Maher, Paulo Ferreira, Fiona Blyth

The workshop focuses on back pain in older people and will outline our plan for an international collaboration (Back complaints in the elderly: BACE) to create standardized methodology, initiate cohort studies and share data. We argue for the need for large, longitudinal studies on the burden and characterization of low back pain in older people (Back Complaints in the Elderly – BACE). This initiative follows the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement, which aims to improve the quality of prospective cohort studies of low back pain, and evolved as a result of discussions held during the VI Low Back Pain Forum. The workshop will begin with an overview of BACE and then seek advice from participants on issues such as options for funding, governance structure for the project, key countries which should be included in the consortium, and availability of the database. All participants will be sent key studies in preparation for the workshop, as well as a short questionnaire, gathering information on how interested participants would be in becoming part of the consortium.

2.6.6 Troublesome translation: designing implementation interventions to improve the management of low back pain in primary care

The workshop facilitators are Simon French, Denise O'Connor, Nadine Foster, Geert Rutten, Matthew Page

This workshop will be of interest to researchers and clinicians who wish to translate best evidence into primary care practice to improve the management of low back pain (LBP). Evidence-based clinical practice guidelines outline best practice for the management of LBP yet there is often a mismatch between guideline recommendations and routine primary care practice. Implementation research is the study of methods to promote the systematic uptake of evidence-based practices into routine practice to improve the quality of health care. To date, the best strategies to support meaningful changes in everyday clinical practice are not known. The main objective of this workshop is to share experiences and best practice in the design and delivery of implementation interventions to improve the management of LBP in primary care settings. Participants will engage in small group work to explore different aspects of the implementation intervention development process. Participants will be encouraged to bring along their own examples of developing implementation interventions, or will be provided with a case study.