“Low Back Pain: A global and urgent public health problem” by Prof. Eduardo Cruz
Low Back Pain is a symptom and not a disease. It’s a public health growing problem, by the increasing incidence and degree of disability caused by the current arising burdens of work absenteeism, by complementary tools of diagnosis expenses, therapeutic tools, early retirement and disability compensation, loss of productivity, among others issues.
The prevalence of low back pain and overall disability related to persistent (chronic) back pain continues to increase and the patient’s outcome has not being improved. In Portugal, the global burden of this condition is higher than the average established for countries with the same socio-demographic index (SDI) as defined by the Institute for Health Metrics and Evaluation (IHME). Between 1990 and 2016, along with the neck pain, went from 3rd to 1st condition in the total percentage of “disability-adjusted life years lost (DALY’s)”, with a rise of 22.8%. The health care process tends to be fragmented, with many health professionals providing contradictory information and interventions of varying effectiveness.
Contextual factors, such as oversupply of treatment options, short length of the medical appointments, high workload, lack of training, or reliance on non-pharmacological treatments have often been identified as barriers to implementing the best available evidence.
Then SPLIT project and the SARA and My Back projects (extensions of SPLIT Project) were born, whose methods are linked to the science of implementation, with the aim of promoting the systematic acceptance of research results in routine clinical practice and improving the quality and effectiveness of health services and care. In common, the projects use a hybrid design to simultaneously assess the impact of interventions in real contexts (effectiveness) and the implementation strategy.
The SPLIT Project was developed to compare the effectiveness and cost-effectiveness of an innovative evaluation program and the stratified treatment of Physiotherapy that associates specific typologies of treatment to different risk subgroups of developing persistent and disabling pain (chronic), with usual clinical practice, in individuals with an episode of low back pain who seek primary care.
The work developed at ACES Arrábida was extended to ACES Arco Ribeirinho and is in the initial phase of implementation at ACES Alentejo Central. This aspect demonstrates the real potential of transferring research results in the implementation of innovative practices at the level of primary health care.
The SPLIT Project extends to other projects such as SARA (SPLIT Application for Remote Rehabilitation) and MyBack Project. SARA is a co-creation of a telerehabilitation service for the assessment and treatment of low back pain: Proof of Concept. The MyBack Project aims at the effectiveness and implementation of a personalized self-management program to prevent recurrences and disability and promote musculoskeletal health in patients with low back pain.
This was a project promoted by the Health School of the Polytechnic Institute of Setúbal, in partnership with NOVA Medical School / Faculty of Medical Sciences of the NOVA University of Lisbon and the Regional Health Administration of Lisbon and Vale do Tejo, through the ACES Arrábida.
This project counts with the contribution of the integrated researchers of the CHRC, Eduardo Cruz (leader researcher of the projects, ESS/IPS; CHRC), Rita Fernandes (ESS/IPS; CHRC), Ana Rodrigues (NOVA NMS/FCM; CHRC), Helena Canhão (NOVA NMS/FCM; CHRC), Jaime Branco (NOVA NMS/FCM; CHRC), Rute Sousa (NOVA NMS/FCM; CHRC), Fernando Pimentel-Santos (NOVA NMS/FCM; CHRC).
Know more at https://split.ips.pt/