• Louise K Wiles, Peter D Hibbert, Jacqueline H Stephens, Charlotte Molloy, Chris G Maher, Rachelle Buchbinder, G Lorimer Moseley, Peter B O'Sullivan, Ivan Lin, Andrew M Briggs, Helen Slater, Ian A Harris, Stephen Jan, Andrew Dwyer, Kieran Fallon, Malcolm Hogg, Kal Fried, Chris Needs, Petrina Casey, Roya Dabestani, Debra Kay, Jeffrey Braithwaite, and William B Runciman.
• IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia.
• Spine. 2022 Jun 15; 47 (12): 879-891.

Study DesignMultiround wiki-based Delphi expert panel survey.ObjectiveTo provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP).Summary Of Background DataThe provision of inappropri ate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recom mendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care."MethodsDraft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators.ResultsFrom seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators compris ing screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided.ConclusionThese 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/ funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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