The Spine Team Assessment for chronic back pain disability. Part 1: basic protocol and performance in 500 patients.

PURPOSE: For persons with chronic back pain disability, customized, effective, and efficient treatment depends on the initial assessment. Functional capacity evaluations and intake screenings for particular programs are not independent or goal-directed. This paper describes a standardized independent multidisciplinary assessment for treatment planning, and characteristic findings in a population of chronically disabled persons. METHODS: The Spine Team Assessment (STA), a (1/2)-day assessment including extensive intake information, evaluations by therapists and counselors, a team meeting with a physician, and a comprehensive report, was performed on 500 consecutive persons with chronic back pain. RESULTS: Representative findings included maximum cardiac performance of 5.33 (+/-4.08 SD) METS; Progressive Isoinertial Lifting Evaluation floor-to-waist of 36.4% (+/-23.9% of norms, and CESD depression scores of 24.7 (+/-13.5 SD). Fear and avoidance and poor physiologic effort were common. CONCLUSION: Deconditioning, psychosocial factors and functional deficits are common, complex, and variable among chronic back pain patients. This description of the STA provides a potentially reproducible standard for research into individualized treatment. The work provides benchmark data for independent multidisciplinary assessments.

The Spine Team Assessment for chronic back pain disability. Part 2: team decision making and a preliminary outcome study.

PURPOSE: Back pain disability is complex, involving medical, physical, functional, social, and financial issues. This study aims to develop the first codified decision making process for individualized treatment planning. METHODS: In a multidisciplinary assessment protocol for chronic low back pain disability, the Spine Team Assessment (see Part I), a 'case law' qualitative approach to decision making began with a basic framework. Details were established over 103 cases at a community hospital. Through 500 more cases, a university spine program developed new exceptions, definitions, and rule clarifications. RESULTS: The final framework includes physical deconditioning, psychosocial factors, and potential for cure, with dozens of subcategories. Seventeen different combinations of therapy were recommended. Of 68 persons referred to one multidisciplinary treatment protocol, at 6 - 12 months the 17 completers had less work disability (31 vs. 62%, p = 0.032) and tended towards fewer subsequent diagnostic tests (17.6 vs. 34.7%) and less surgery (0 vs. 4). CONCLUSIONS: The data suggests that the process is complex, that customization did occur, and that at least one team decision led to better outcomes. While derived qualitatively, this decision-making tree provides a road map for less experienced teams and a precedent for researchers who wish to study individualized treatment.