CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Low back pain
This tool provides information to facilitate the management of recent onset and persistent low back pain for adults.
Focused examination
1. Patient History
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Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery (e.g., using the STartBack Tool).
Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):
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Cancer (history of cancer, unexplained weight loss, nocturnal pain, age >50), vertebral infection (fever, intravenous drug use, recent infection), cauda equina syndrome (urinary retention, motor deficits at multiple levels, fecal incontinence, saddle anesthesia), osteoporotic fractures (history of osteoporosis, use of corticosteroid, older age), ankylosing spondylitis (morning stiffness, improvement with exercise, alternative buttock pain, awakening due to back pain during the second part of the night, younger age), inflammatory arthritis (morning stiffness, swelling in multiple joints)
Examples of other conditions/co-morbidities:
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Physical conditions: neck pain, headache
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Psychological conditions: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Assess levels of concern regarding major structural or other pathologies.
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Assess for neurological signs.
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Identify type of low back pain.
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Avoid routine imaging.
Non-specific low back pain: pain not caused by specific pathologies (e.g., fracture, dislocation, tumor, or systemic disease)
Low back pain with radiculopathy (sciatica): spine-related symptoms or deficits, interference with function or activities of daily living and focal pathology compromising neural structures
3. Management
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Offer information on nature, management, and the course of low back pain (i.e., most low back pain is benign and self-limiting).
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Discuss the range of effective interventions with the patient and, together, a therapeutic intervention.
Patient Handouts
Management of recent onset (0-3 months duration) non-specific low back pain
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider exercise (strengthening/range of motion, aerobic, mind-body or a combination of approaches); group-based or individual, supervised or home-based
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Consider manipulation
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Consider multimodal careᶧ:
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combination of exercise and cognitive behavioral therapy (CBT) (for patients who have high levels of disability or significant distress) with or without manual therapy (spinal manipulation, mobilization or soft tissue techniques)
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combination of exercise and manual therapy (spinal mobilization or soft tissue techniques) with or without psychological therapy
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Consider muscle relaxants
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Consider non-steroidal anti-inflammatory drugs (short course for pain only, assess pain relief and discontinue if lack of clinical benefit)
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Do not offer massage alone
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Do not offer traction
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Do not offer passive physical modalities (PENS, TENS, ultrasound, interferential therapy, belts or corsets, foot orthotics, rocker sole shoes)
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Do not routinely offer opioids, paracetamol, selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors or tricyclic antidepressants, anticonvulsants
Management of persistent (4-6 months duration) non-specific low back pain
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider exercise (strengthening/range of motion, aerobic, mind-body or a combination of approaches); group-based or individual, supervised or home-based
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Consider manipulation or mobilization
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Consider clinical or relaxation massage
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Consider needle acupuncture
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Consider multimodal careᶧ:
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exercise and cognitive behavioral therapy (CBT) (for patients who have high levels of disability or significant distress) with or without manual therapy (spinal manipulation, mobilisation or soft tissue techniques)
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exercise and manual therapy (spinal manipulation, mobilisation or soft tissue techniques) with or without psychological therapy
-
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Consider non-steroidal anti-inflammatory drugs (short course for pain only, assess pain relief and discontinue if lack of clinical benefit)
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Do not offer passive physical modalities (PENS, TENS, ultrasound, laser, interferential therapy, belts or corsets, foot orthotics, rocker sole shoes)
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Do not offer traction
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Do not offer botulinum toxin injections
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Do not offer paracetamol, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants, anticonvulsants, epidural injections of local anaesthetic and steroid, epidural injections for neurogenic claudication
Management of recent onset (0-3 months duration) lumbar disc herniation with radiculopathy
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider manipulation
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Consider multimodal careᶧ:
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manipulation and exercise
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Management of persistent (4-6 months duration) lumbar disc herniation with radiculopathy
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and:
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refer to appropriate healthcare provider for consideration of further investigation of the neurological deficits
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
ᶧMultimodal care: treatment involving at least two distinct therapeutic modalities, provided by one or more health care disciplines.
Care pathway for the management of lumbar disc herniation with radiculopathy
Exercise Videos
The low back pain videos are based on the recommendations from the Clinical Practice Guideline for the Treatment of Low Back Pain Pain. Select a link below to view the patient exercise videos for low back pain.
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors for delayed recovery.
Outcome Measures
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.
Additional Resources
