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The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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References

  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, DC

    Google Scholar 

  2. March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F et al (2014) Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol 28(3):353–366

    Article  PubMed  Google 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):743–800

    Article  Google Scholar 

  4. Hoy D, Geere JA, Davatchi F, Meggitt B, Barrero LH (2014) A time for action: opportunities for preventing the growing burden and disability from musculoskeletal conditions in low- and middle-income countries. Best Pract Res Clin Rheumatol 28(3):377–393

    Article  PubMed  Google Scholar 

  5. Jackson T, Thomas S, Stabile V, Han X, Shotwell M, McQueen K (2015) Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 385(Suppl 2):S10

    Article  PubMed  Google Scholar 

  6. Vancampfort D, Koyanagi A, Ward PB, Rosenbaum S, Schuch FB, Mugisha J et al (2017) Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. Int J Behav Nutr Phys Act 14(1):6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC et al (2008) Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 9(10):883–891

    Article  PubMed  Google Scholar 

  8. Burns AS, O’Connell C (2012) The challenge of spinal cord injury care in the developing world. J Spinal Cord Med 35(1):3–8

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MW (2015) Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology 44(3):182–198

    Article  PubMed  Google Scholar 

  10. Rasanathan K, Sivasankara Kurup A, Jaramillo E, Lonnroth K (2011) The social determinants of health: key to global tuberculosis control. Int J Tuberc Lung Dis 15(Suppl 2):S30–S36

    Article  Google Scholar 

  11. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W et al (2008) Expenditures and health status among adults with back and neck problems. JAMA 299(6):656–664

    Article  CAS  PubMed  Google 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):e0127880

    Article  PubMed  PubMed Central  Google Scholar 

  13. Louw QA, Morris LD, Grimmer-Somers K (2007) The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord. 8:105

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rojas M, Gimeno D, Vargas-Prada S, Benavides FG (2015) Musculoskeletal pain in Central American workers: results of the first survey on working conditions and health in Central America. Rev Panam Salud Publica 38(2):120–128

    PubMed  Google Scholar 

  15. Spiegel DA, Gosselin RA, Coughlin RR, Joshipura M, Browner BD, Dormans JP (2008) The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. J Bone Joint Surg Am 90(4):915–923

    Article  PubMed  Google 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 13:147

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wajed J, Ahmad Y, Durrington PN, Bruce IN (2004) Prevention of cardiovascular disease in systemic lupus erythematosus–proposed guidelines for risk factor management. Rheumatology (Oxford) 43(1):7–12

    Article  CAS  Google 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):190–196

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  20. Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL et al (2018) The Global Spine Care Initiative: classification system for spine-related concerns. Eur Spine J. https://doi.org/10.1007/s00586-018-5724-8

    Article  PubMed  Google Scholar 

  21. Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL et al (2018) The Global Spine Care Initiative: care pathway for people with spine-related concerns. Eur Spine J. https://doi.org/10.1007/s00586-018-5721-y

    Article  PubMed  Google Scholar 

  22. Johnson CD, Haldeman S, Chou R, Nordin M, Green BN, Côté P, Hurwitz EL et al (2018) The Global Spine Care Initiative: model of care and implementation. Eur Spine J. https://doi.org/10.1007/s00586-018-5720-z

    Article  PubMed  Google Scholar 

  23. Johnson CD, Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL et al (2018) The Global Spine Care Initiative: methodology, contributors, and disclosures. Eur Spine J. https://doi.org/10.1007/s00586-018-5723-9

    Article  PubMed  Google Scholar 

  24. Green BN, Johnson CD, Haldeman S, Griith E, Clay MB, Kane EJ et al (2018) A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLOS ONE 13(6):e0197987. https://doi.org/10.1371/journal.pone.0197987

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tricco AC, Lillie E, Zarin W, O’Brien K, Colquhoun H, Kastner M et al (2016) A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol 16:15

    Article  PubMed  PubMed Central  Google 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

  27. Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344(5):363–370

    Article  CAS  PubMed  Google Scholar 

  28. Elfering A, Mannion AF (2008) Epidemiology and risk factors of spinal disorders. In: Boos N, Aebi M (eds) Spinal disorders: fundamentals of diagnosis and treatment. Springer, Berlin, pp 153–173

    Chapter  Google Scholar 

  29. Haldeman S, Kopansky-Giles D, Hurwitz EL, Hoy D, Mark Erwin W, Dagenais S et al (2012) Advancements in the management of spine disorders. Best Pract Res Clin Rheumatol 26(2):263–280

    Article  PubMed  Google Scholar 

  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, Geneva

    Google Scholar 

  31. Friis RH, Sellers TA (2009) Epidemiology for public health practice, 4th edn. Jones and Bartlett Publishers, Sudbury, p 717

    Google Scholar 

  32. Rothstein WG (2003) Public health and the risk factor: a history of an uneven medical revolution. University of Rochester Press, Rochester, p 466

    Google Scholar 

  33. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M (2009) Defining comorbidity: implications for understanding health and health services. Ann Fam Med 7(4):357–363

    Article  PubMed  PubMed Central  Google Scholar 

  34. Starfield B, Hyde J, Gervas J, Heath I (2008) The concept of prevention: a good idea gone astray? J Epidemiol Community Health 62(7):580–583

    Article  CAS  PubMed  Google Scholar 

  35. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE et al (2011) Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 378(9802):1560–1571

    Article  PubMed  PubMed Central  Google Scholar 

  36. Norris SL, Kansagara D, Bougatsos C, Fu R (2008) Force USPST. Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 148(11):855–868

    Article  PubMed  Google Scholar 

  37. Vernon H (2008) The Neck Disability Index: state-of-the-art, 1991-2008. J Manip Physiol Ther 31(7):491–502

    Article  Google Scholar 

  38. MacAvoy S, Skinner T, Hines M (1996) Fall risk assessment tool. Appl Nurs Res 9(4):213–218

    Article  CAS  PubMed  Google Scholar 

  39. Preventive US (2011) Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 154(5):356–364

    Article  Google 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):1237–1246

    Article  PubMed  Google 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

  42. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S et al (2016) Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract 17:68

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jeremiah MP, Unwin BK, Greenawald MH, Casiano VE (2015) Diagnosis and management of osteoporosis. Am Fam Phys 92(4):261–268

    Google 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 120–144

    Google Scholar 

  45. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 25(10):2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A et al (2015) Calcium intake and risk of fracture: systematic review. BMJ 351:h4580

    Article  PubMed  PubMed Central  Google Scholar 

  47. Reid IR, Bolland MJ, Grey A (2014) Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 383(9912):146–155

    Article  CAS  PubMed  Google 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:CD005119

    Google Scholar 

  49. Nguyen VH (2017) Community osteoporosis screening services for the prevention of osteoporotic fractures in population health: a literature review. Int J Evid Based Healthc 15(2):43–52

    Article  PubMed  Google Scholar 

  50. Dinh-Zarr TB, Sleet DA, Shults RA, Zaza S, Elder RW, Nichols JL et al (2001) Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med 21(4 Suppl):48–65

    Article  CAS  PubMed  Google Scholar 

  51. Lee BB, Cripps RA, Fitzharris M, Wing PC (2014) The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord 52(2):110–116

    Article  CAS  PubMed  Google Scholar 

  52. Jazayeri SB, Beygi S, Shokraneh F, Hagen EM, Rahimi-Movaghar V (2015) Incidence of traumatic spinal cord injury worldwide: a systematic review. Eur Spine J 24(5):905–918

    Article  PubMed  Google Scholar 

  53. van den Berg ME, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I (2010) Survival after spinal cord injury: a systematic review. J Neurotrauma 27(8):1517–1528

    Article  PubMed  Google Scholar 

  54. Kraft R, Dorstyn D (2015) Psychosocial correlates of depression following spinal injury: a systematic review. J Spinal Cord Med 38(5):571–583

    Article  PubMed  PubMed Central  Google Scholar 

  55. Craig A, Tran Y, Middleton J (2009) Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord 47(2):108–114

    Article  CAS  PubMed  Google Scholar 

  56. Dijkers M, Bryce T, Zanca J (2009) Prevalence of chronic pain after traumatic spinal cord injury: a systematic review. J Rehabil Res Dev 46(1):13–29

    Article  PubMed  Google Scholar 

  57. Gilbert O, Croffoot JR, Taylor AJ, Nash M, Schomer K, Groah S (2014) Serum lipid concentrations among persons with spinal cord injury—a systematic review and meta-analysis of the literature. Atherosclerosis 232(2):305–312

    Article  CAS  PubMed  Google Scholar 

  58. Xing D, Wang J, Song D, Xu W, Chen Y, Yang Y et al (2013) Predictors for mortality in elderly patients with cervical spine injury: a systematic methodological review. Spine (Phila Pa 1976) 38(9):770–777

    Article  Google 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):1079–1087

    Article  Google Scholar 

  60. World Health Organization (2007) Preventing Injuries and violence: a guide for ministries of health. World Health Organization, Geneva

    Google Scholar 

  61. World Health Organization (2013) Global status report on road safety 2013. World Health Organization, Geneva

    Google Scholar 

  62. Krug EG, Sminkey LA (2007) The role of the ministry of health in preventing injuries and violence. Int J Inj Contr Saf Promot 14(3):199–201

    Article  PubMed  Google Scholar 

  63. Cooper BS, Medley GF, Stone SP, Kibbler CC, Cookson BD, Roberts JA et al (2004) Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 101(27):10223–10228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Lonnroth K, Castro KG, Chakaya JM, Chauhan LS, Floyd K, Glaziou P et al (2010) Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet 375(9728):1814–1829

    Article  PubMed  Google Scholar 

  65. Kamara E, Mehta S, Brust JC, Jain AK (2012) Effect of delayed diagnosis on severity of Pott’s disease. Int Orthop 36(2):245–254

    Article  PubMed  PubMed Central  Google Scholar 

  66. Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res 460:86–92

    CAS  PubMed  Google 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):716–724

    Article  CAS  PubMed  Google Scholar 

  68. Lonnroth K, Migliori GB, Abubakar I, D’Ambrosio L, de Vries G, Diel R et al (2015) Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 45(4):928–952

    PubMed  PubMed Central  Google 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):412–421

    Article  PubMed  PubMed Central  Google Scholar 

  70. Susser M, Susser E (1996) Choosing a future for epidemiology: I. Eras and paradigms. Am J Public Health 86(5):668–673

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Krieger N, Zierler S (1996) What explains the public’s health?—A call for epidemiologic theory. Epidemiology 7(1):107–109

    Article  CAS  PubMed  Google Scholar 

  72. Susser M, Susser E (1996) Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health 86(5):674–677

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Broadbent A (2009) Causation and models of disease in epidemiology. Stud Hist Philos Biol Biomed Sci 40(4):302–311

    Article  PubMed  Google Scholar 

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Funding

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.

Author information

Authors and Affiliations

  1. Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA

    Bart N. Green & Claire D. Johnson

  2. National University of Health Sciences, Lombard, IL, USA

    Bart N. Green & Claire D. Johnson

  3. Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA

    Scott Haldeman

  4. Department of Neurology, University of California, Irvine, Irvine, CA, USA

    Scott Haldeman

  5. World Spine Care, Santa Ana, CA, USA

    Scott Haldeman

  6. College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA

    Edward J. Kane

  7. Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA

    Michael B. Clay

  8. Emergency Medicine, Carlsbad, CA, USA

    Erin A. Griffith

  9. National School of Occupational Medicine, Carlos III Institute of Health, Madrid, Spain

    Juan M. Castellote

  10. Physical Medicine and Rehabilitation Department, University Complutense, Madrid, Spain

    Juan M. Castellote

  11. Physical Medicine and Rehabilitation Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA

    Matthew Smuck

  12. Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamilnadu, India

    Shanmuganathan Rajasekaran

  13. Office of Public Health Studies, University of Hawai’i, Mānoa, Honolulu, HI, USA

    Eric L. Hurwitz

  14. Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA

    Margareta Nordin

  15. World Spine Care Europe, Holmfirth, UK

    Margareta Nordin

  16. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada

    Kristi Randhawa & Hainan Yu

  17. UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada

    Kristi Randhawa & Hainan Yu

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  1. Bart N. Green
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  2. Claire D. Johnson
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  9. Shanmuganathan Rajasekaran
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Corresponding author

Correspondence to Claire D. Johnson.

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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.

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Green, B.N., Johnson, C.D., Haldeman, S. et al. The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities. Eur Spine J 27 (Suppl 6), 838–850 (2018). https://doi.org/10.1007/s00586-018-5635-8

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