Promoting Public Health >>Promoting Public Health among Health Professionals Development and Distribution of European Guidelines for the Treatment of Back Disorders

DEVELOPMENT AND DISTRIBUTION OF EUROPEAN GUIDELINES FOR THE TREATMENT OF BACK DISORDERS

Background.

Back disorders represent a major problem for industrialized countries, both because they are so widespread and because of their cost in both labor and health terms. Furthermore, available studies show that practicing physicians do not tend to consider the results of scientific studies when they decide on the recommendations they make to their patients with back problems.

This ends up meaning that a large number of patients are being subjected to inadequate diagnostic procedures and treatments or ones that are not suited to their specific case. Furthermore, it means that these patients generate a greater cost than is necessary. This problem affects most European countries equally, even though initiatives have been made in some to confront it in a rational fashion.

To this end, the Kovacs Foundation has promoted the elaboration of a set of evidence-based practical guidelines for Europe. The objective of the guidelines is to define the optimal management of patients with any kind of back ailment, based on the summary of scientific studies made throughout the world and with the consensus of leading European expert.

up

Objective.

The final objective is to help practicing physicians ensure that their prescriptions and recommendations are based on the most up-to-date scientific evidence so that their patients receive the most appropriate treatments for their specific case. To this end, the project consists of preparing and distributing a set of evidence-based guidelines for clinical practice that provides doctors with a clear and comprehensible standard based on the most reliable and up-to-date scientific information.

up

Description.

To carry out this project, a pan-European proposal has been put into effect through the European Commission's COST program. A "Managing Committee" has also been formed, bringing together Europe's leading researchers and clinics in the field of back disorders. Because of the COST program's work system, the experts have had to be named by the national governments of each one of the countries participating in the program. Among these experts, most have participated in the elaboration of already existing evidence-based clinical guidelines for the different European countries.

Additionally, the Managing Committee has formed three work groups centered on defining the recommendations for the prevention of pain, for acute pain and for chronic pain, respectively. Each one of these Work Groups is made up of members of the Managing Committee and other experts specialized in the subject and who have been chosen on the basis of the importance of their scientific work in the corresponding field.

One of the two Kovacs Foundation experts representing Spain in the Managing Committee has been unanimously elected as its Vice President.

In short, the COST B13 program is responsible for:

1. Analyzing the available scientific evidence on each one of the relevant procedures for its area (prevention or diagnosis and treatment of acute or chronic low back pain).

2. Approving a recommendation, based on the available scientific evidence on the use or avoidance of each procedure.

3. Combining the recommended diagnostic and therapeutic procedures, defining a protocol for behavior that assures the greatest efficacy and efficiency (relationship of cost/outcome) possible of the available resources.

4. Promote the use of this protocol. It is likely that not all of the technologies the Guide mentions are available in all settings, so that the "optimal" protocol, stemming directly from scientific evidence, needs to be adapted by local groups to apply it in a specific territory. Thus the COST B13 program Guide is conceived as a solid base from which the European health authorities can define their own guidelines for clinical practice without having to go back to find and evaluate all of the scientific studies made. To ensure the transparence and accessibility of the COST B13 program Guideline, a summary will be published in the most important scientific journals in the world in the field of back problems and its complete version will be available free on the Internet.

In order to avoid needless repetition, the COST B13 program bears in mind the previous work done by other groups, such as the Cochrane Collaboration, the Agency for Health Care Policy and Research (USA), the Royal College of General Practitioners (United Kingdom) and the Swedish Agency for the Evaluation of Health Care Technologies (Sweden- SBU).

However, most of these groups have formulated their recommendations on the basis of scientific studies published in English only. Furthermore, the political and economic pressures that certain groups of professionals have exercised in some countries have resulted in contradictory recommendations formulated by different groups on the basis of the same evidence. Additionally, all of these Guidelines have been centered on handling patients with acute ailments, but nearly none has provided recommendations on prevention or for the treatment of chronic patients, who generate more than 80% of the global costs derived from back problems.

For that reason, the B13 Management Committee reviews and brings up-to-date the scientific evidence on which these recommendations are based and incorporates the reliable scientific studies published in other languages. It includes the scientific evidence referring to chronic cases and to the mechanisms of prevention in order to provide more complete information. Also, as it is a Pan-European venture, it is better prepared to resist the pressures that some professional groups might exercise on a local or national level.

Furthermore, the medical Societies representative of the specialists involved in the handling and treatment of patients with back disorders (primary care physicians, radiologists, rehabilitation therapists, rheumatologists, traumatologists, neurosurgeons, specialists in occupational medicine etc.) have been invited to participate in its development and publication. Special attention is paid to assuring that its final recommendations are clear and easy to apply. Thus, the Foundation has funded and organized the constitution of a Spanish Work Group made up of specialists designated by all of the pertinent Spanish Scientific societies in the field. Their work consists of communicating the scientific studies published in Spanish, which the Managing Committee may have overlooked, comment on the Guideline drafts, collaborate in its distribution and promote its application.

up

Along with the Kovacs Foundation, the following have participated in this project.

The main experts in mechanical pathologies of the spine of the different European countries who participate as members of the Managing Committee and/or of the Work Groups. There are in all 49 experts from Austria, Belgium, Denmark, Finland, France, Germany, Holland, Italy, Israel, Norway, Spain, Sweden, Switzerland, and the United Kingdom.
Additionally, in the Spanish Work Group, there are 14 experts from 10 Spanish Scientific societies representative of their disciplines, relevant to the diagnosis and treatment of back problems.

The Spanish portion is funded entirely by the Kovacs Foundation. The COST organization, under the European Commission's Secretariat for Research is responsible for funding the international coordination.

up

Status.

This project was approved by the European Commission's Secretariat of Research, and was begun in October 1999. The preparation of the clinical guidelines is in progress and its final version is expected to be presented in January 2005.