Multidisciplinary team-based management approach for secondary-care patients with severe and persistent low back pain: A mixed-method feasibility trial

Article type: Research Article

Authors: Nim, Casper Glissmann^{a; b; c; *} | Hansen, Anders^{a; b} | Backmann, Tina^a | Ziegler, Dorthe Schøler^{a; b} | O’Neill, Søren^{a; b}

Affiliations: [a] Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark | [b] Department of Regional Health Research, University of Southern Denmark, Odense, Denmark | [c] Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

Correspondence: [*] Corresponding author: Casper Glissmann Nim, Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark. E-mail: casper.nim@rsyd.dk.

Abstract: BACKGROUND: Persistent and severe low back pain is challenging to treat. Multidisciplinary care with systematic follow-up may be more effective than usual care. However, such a model has yet to be developed and tested. OBJECTIVE: Our objectives were to develop and test the feasibility of a three-month multidisciplinary intervention with systematic follow-up in a specialized hospital spine center for patients with severe and persistent low back pain. METHODS: Using the Medical Research Council and National Institute for Health and Care Research framework for the development and testing of complex interventions, we developed a multidisciplinary intervention with systematic follow-up and tested its feasibility, using a-priori-determined outcomes during three months for 24 patients seen at a regional diagnostic spine center unit. As part of the evaluation, we conducted semi-structured interviews with participants and a focus-group interview with clinicians. RESULTS: Of the 24 patients included, only 17 completed the course of care and provided complete data for feasibility assessment. We failed to reach our a-priori feasibility outcomes, had difficulty with inclusion, and participants did not find the intervention effective or satisfactory. CONCLUSIONS: The intervention was not feasible as barriers existed on multiple levels (e.g., clinical, administrative, and patient). Excessive study moderations must be made before the intervention is feasible in a randomized trial.

Keywords: Hospital medicine, secondary care, methods, health care quality, access, and evaluation

DOI: 10.3233/BMR-220369

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 4, pp. 979-991, 2023