Development of an internationally agreed national minimum dataset for low back pain: a modified Delphi study

Abstract

BACKGROUND: Low back pain is the leading cause of disability worldwide and the burden is expected to rise due to increases in ageing and population growth. The 2018 Lancet Low Back Pain Series proposed urgent actions to reverse the rising trend of disability due to low back pain including the need for a set of data indicators to routinely monitor progress in achieving these actions worldwide. PURPOSE: To reach international consensus on a national minimum dataset of low back pain indicators that could be used across all countries to monitor progress in improving care and reducing disability from low back pain. STUDY DESIGN: Modified Delphi study. SAMPLE: Nineteen participants attended a preliminary workshop at the 2023 International Back and Neck Pain Forum, The Netherlands. Subsequently, 305 and 339 participants (researchers, clinicians, policy makers, educators and consumers) completed Delphi surveys Rounds 1 and 2, respectively. OUTCOME MEASURES: A 9-point Likert scale rated importance and feasibility of low back pain indicators (1=not important/feasible; 9=extremely important/feasible, 0 unsure). In Round 2, indicators that achieved consensus on importance and feasibility were ranked 'most important' (top-ranked) to 'least important'. METHODS: Workshop participants were divided into four groups and asked to independently consider the importance and feasibility of 105 indicators identified from previous reviews divided into six themes. Participants could remove indicators considered unimportant or not feasible. This required unanimous agreement from independent workshop groups. Participants could also suggest improvements to the wording of indicators, the best unit of measure and additional missing indicators. RESULTS: Thirty-eight indicators were recommended by workshop participants for inclusion in the Delphi study. Survey responses over two rounds reached consensus for 21 indicators (11 burden, 10 care) ranked from most to least important after reaching consensus on importance and feasibility in Round 1. Number of work days lost and number of opioid prescriptions for low back pain were the highest ranked indicators for burden and care respectively. Importance rankings were similar across subgroups comparing high-income and low- and middle-income countries, and consumers and non-consumers. CONCLUSION: We reached international consensus that 21 indicators could be used to monitor progress in improving care and outcomes for people with low back pain globally. Future work is needed to confirm the acceptability and feasibility of these indicators across countries, and, if implemented, to determine their value over time