The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities
- 171 Downloads
The purpose of this study was to develop recommendations for prevention interventions for spinal disorders that could be delivered globally, but especially in underserved areas and in low- and middle-income countries.
We extracted risk factors, associations, and comorbidities of common spinal disorders (e.g., back and neck pain, spinal trauma, infection, developmental disorders) from a scoping review of meta-analyses and systematic reviews of clinical trials, cohort studies, case control studies, and cross-sectional studies. Categories were informed by the Global Spine Care Initiative (GSCI) classification system using the biopsychosocial model. Risk factors were clustered and mapped visually. Potential prevention interventions for individuals and communities were identified.
Forty-one risk factors, 51 associations, and 39 comorbidities were extracted; some were associated with more than one disorder. Interventions were at primary, secondary, tertiary, and quaternary prevention levels. Public health-related actions included screening for osteopenia, avoiding exposure to certain substances associated with spinal disorders, insuring adequate dietary intake for vitamins and minerals, smoking cessation, weight management, injury prevention, adequate physical activity, and avoiding harmful clinical practices (e.g., over-medicalization).
Prevention principles and health promotion strategies were identified that were incorporated in the GSCI care pathway. Interventions should encourage healthy behaviors of individuals and promote public health interventions that are most likely to optimize physical and psychosocial health targeting the unique characteristics of each community. Prevention interventions that are implemented in medically underserved areas should be based upon best evidence, resource availability, and selected through group decision-making processes by individuals and the community.
KeywordsHealth promotion Spinal diseases Risk factors Epidemiology
The Global Spine Care Initiative and this study were funded by Grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
Compliance with ethical standards
Conflict of interest
BNG receives speaker fees and travel reimbursement from NCMIC Speakers' Bureau; he is secretary of Brighthall Inc; the views in this article are those of the authors and not those of Stanford University, Stanford Health Care, or Qualcomm. CDJ is president of Brighthall Inc; she is an NCMIC Board of Director, however neither she nor NCMIC board make funding decisions for the NCMIC Foundation; the views in this article are those of the authors and not those of Stanford University, Stanford Health Care, or Qualcomm. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stock holder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement—CMCC Board. EJK declares no COI. MBC declares no COI. EAG declares no COI. JMC declares funding from Spanish Government Grant ESPY 112/18. MS declares no COI. SR declares no COI. EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences Data and Safety Monitoring Committee. Chair, Palmer Center for Chiropractic Research. Research Committee Co-chair, World Spine Care. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee. Palladian Health, Clinical Policy Advisory Board member. Book Royalties Wolters Kluwer and Springer. Honoraria for speaking at research method courses. PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care.
- 1.Connelly LB, Woolf A, Brooks P (2006) Cost-effectiveness of interventions for musculoskeletal conditions. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB et al (eds) Disease control priorities in developing countries, 2nd edn. World Bank, Washington, DCGoogle Scholar
- 3.Global Burden of Disease Study Collaborators (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386(9995):743–800CrossRefGoogle Scholar
- 12.Stewart Williams J, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T et al (2015) Risk Factors and disability associated with low back pain in older adults in low- and middle-income countries. Results from the WHO study on global AGEing and adult health (SAGE). PLoS ONE 10(6):e0127880CrossRefGoogle Scholar
- 16.Stewart Williams J, Kowal P, Hestekin H, O’Driscoll T, Peltzer K, Yawson A et al (2015) Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE). BMC Med 13:147CrossRefGoogle Scholar
- 18.Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F (2007) Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing 36(2):190–196CrossRefGoogle Scholar
- 19.Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL, Johnson CD, Randhawa K et al (2018) The Global Spine Care Initiative: World Spine Care executive summary on reducing spine-related disability in low- and middle-income communities. Eur Spine J. https://doi.org/10.1007/s00586-018-5722-x CrossRefGoogle Scholar
- 26.International Association for the Study of Pain Taxonomy Working Group (2011) Classification of Chronic Pain. 2nd (revised) ed. International Association for the Study of Pain, Washington, DC. http://www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&navItemNumber=677. Accessed 16 Oct 2016
- 30.Mathers C, Stevens G, Mascarenhas M (2009) Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization Press, GenevaGoogle Scholar
- 31.Friis RH, Sellers TA (2009) Epidemiology for public health practice, 4th edn. Jones and Bartlett Publishers, Sudbury, p 717Google Scholar
- 32.Rothstein WG (2003) Public health and the risk factor: a history of an uneven medical revolution. University of Rochester Press, Rochester, p 466Google Scholar
- 40.Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA et al (2009) Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 50(5):1237–1246CrossRefGoogle Scholar
- 41.World Health Organization (2006) Guidelines for drinking-water quality. World Health Organization, Geneva. http://www.who.int/water_sanitation_health/dwq/gdwq0506.pdf. Accessed 2 Mar 2017
- 43.Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE (2015) Diagnosis and management of osteoporosis. Am Fam Phys 92(4):261–268Google Scholar
- 44.McKenzie JF, Pinger RR, Kotecki KE (2008) Community organization/building and health promotion programming. In: McKenzie JF (ed) An introduction to community health. Jones and Bartlett Publishers, Sudbury, pp 120–144Google Scholar
- 48.Winzenberg TM, Shaw K, Fryer J, Jones G (2006) Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2:CD005119Google Scholar
- 59.van Middendorp JJ, Albert TJ, Veth RP, Hosman AJ (2010) Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors. Spine (Phila Pa 1976) 35(10):1079–1087CrossRefGoogle Scholar
- 60.World Health Organization (2007) Preventing Injuries and violence: a guide for ministries of health. World Health Organization, GenevaGoogle Scholar
- 61.World Health Organization (2013) Global status report on road safety 2013. World Health Organization, GenevaGoogle Scholar
- 67.Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, Shashidhar Reddy J, Naresh-Babu J, Kishen T (2006) Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy. J Pediatr Orthop 26(6):716–724CrossRefGoogle Scholar
- 69.Rodrigues-De-Souza DP, Fernandez-De-Las-Penas C, Martin-Vallejo FJ, Blanco-Blanco JF, Moro-Gutierrez L, Alburquerque-Sendin F (2016) Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain. Braz J Phys Ther 20(5):412–421CrossRefGoogle Scholar