Primary Care Focus On
Low Back Pain Development Process

DEVELOPMENT PROCESS

The development process for the CORE Back Tool 2016 Update built from the process used in 2012 (for more information on the previous process contact: [email protected]).

The CORE Back Tool 2016 Update was developed using Centre for Effective Practice’s integrated knowledge translation approach that ensures we engage health care providers throughout the process. Our process includes a number of activities applying User Centered Design methodology to test the tool during development for usability.

Specifically CEP’s process includes:

  • Updated literature review to identify emerging evidence
  • Engagement of our Clinical Working Group
  • Analysis of feedback from the online course evaluations by providers
  • Execution of a modified Printed Education Material Usability Scale survey completed by providers
  • Focus Groups with providers
  • One on one usability sessions with providers
  • Prototyping and iterative feedback working with our UX Designer
  • Interviews to seek Expert input

The CORE Back Tool 2012 was revised in response to the needs identified by primary care providers to indicate evidence base supporting aspects of the tool, expand on the initial management options, integrate more clearly the patient key messages and improve overall flow of information to align with primary care provider decision making process. The CORE Back Tool 2016 Update has tried to address the feedback received from providers to offer even more value to primary care providers, specifically family physicians and nurse practitioners.

ENDORSEMENT

The following organizations, through invidual membership on the above groups, provided endorsement of the CORE Back Tool 2016:

Canadian Spine Society www.spinecanada.ca

Nurse Practitioners Association of Ontario www.npao.org

CEP is pleased to have also received organization level endorsement for the CORE Back Tool 2016 from:

College of Family Physicians of Canada www.cfpc.ca

If you would like to be engaged and/or endorse the CORE Back Tool or if you are interested in collaborating, modifying or using the toolkit for commercial purposes contact us at [email protected].

REFERENCING

Please use the following reference:

CORE Back Tool 2016 Update:

Centre for Effective Practice (February 2016). CORE Back Tool. Toronto. Centre for Effective Practice.

For our previous material, please use the following references:

Toolkit 2012:

Centre for Effective Practice. Low Back Pain Toolkit for Primary Care Providers. Funded by the Government of Ontario (Provincial Low Back Pain Strategy); 2013. Available from: ontario.ca/lowbackpain and www.effectivepractice.org/lowbackpain.

CORE Back Tool 2012:

Alleyne J, Hall H, Rampersaud R. Clinically Organized Relevant Exam (CORE) Tool for the Low Back Pain Toolkit for Primary Care Providers. Centre for Effective Practice. Funded by the Government of Ontario; 2013. Available from: ontario.ca/lowbackpain and www.effectivepractice.org/lowbackpain.

CORE Back Guide 2012:

Alleyne J, Hall H, Rampersaud R. Clinically Organized Relevant Exam (CORE) Tool for the Low Back Pain Toolkit for Primary Care Providers. Centre for Effective Practice. Funded by the Government of Ontario; 2013. Available from: ontario.ca/lowbackpain and www.effectivepractice.org/lowbackpain.

Funding

In 2015/16, Centre for Effective Practice invested funds to update of the CORE Back Tool.

The initial project was funded by the Government of Ontario as part of its Provincial Low Back Pain Strategy. The Strategy included 3 key components (an amendment to the schedule of benefits, a provincial pilot program and provider education). Centre for Effective Practice was engaged to develop and deliver the provincial provider education that included the original CORE Back Tool, 2012. For more information on this provincial strategy, visit ontario.ca/lowbackpain

ENGAGING PROVIDERS IN THE UPDATE

In updating the CORE Back Tool 2016, the team undertook a number of activities to seek additional input from providers including: review of evaluation data from our online course on the CORE Back Tool (over 5000 providers participated in the online course), results from a survey to primary care providers on the usability of the CORE Back Tool 2012 version, heuristics evaluation to improve flow of information, one on one user centered interviews with primary care providers and engagement with our Clinical Working Group.

This data, builds from the extensive engagement we undertook during the development of the first CORE Back Tool which included three focus groups with Family Physicians and Nurse Practitioners from across Ontario.

As always, we are grateful to the participants for their time and enthusiasm. Participants were recruited through CEP’s quarterly updates – we encourage you to join our database list to stay up to date on projects, tools and opportunities through the work of CEP.

CEP PROJECT TEAM

Jess Rogers, Project Lead
Julia Alleyne, Clinical and Education Lead
Katie Hunter, Project Manager
Claudia Warner-Romano, Information Specialist and Coordinator
Jess Peter, UX Designer

CLINICAL WORKING GROUP

For the 2016 update, we invited members from the CORE Back Tool 2012 Education Planning Committee to participate and expanded membership to include the following:

  • Michelle Acorn, Nurse Practitioner
    John Axler, Family Physician
    Craig Bauman, Chiropractor
    Kerri Deir, Kinesiologist
    David Dos Santos, Chiropractor
    Dale Guenter, Family Physician
    Bruce Hobson, Family Physician
    Jessica Munro, Nurse Practitioner
    Steve Radke, Family Physician
    Hema Rajawat, Pharmacist
    Inge Schabort, Family Physician
    Murray Townsend, Chiropractor
    Kathy Tripp, Nurse Practitioner
    Xu Wang, Family Physician
    Jennifer Young, Family Physician

Thank you to all of our members for their work!

EXPERT INPUT

In addition to our Clinical Working Group, CEP sought Expert input to inform the update including terminology, assessment, management and appropriate referrals.

Hamilton Hall MD, FRCSC

Biography

Y. Raja Rampersaud MD, FRCSC

Dr. Rampersaud is nationally and internationally recognized leader and innovator in minimally invasive spine surgery. Dr. Rampersaud has recently completed a two year term as the president of the Canadian Spine Society and has been instrumental in the development of spine care advocacy efforts across Canada. Dr. Rampersaud is leading the Interprofessional Spine Assessment and Education Centre (ISAEC) Pilot Project funded through Government of Ontario.

USE OF TOOL

The CORE Back Tool 2016 was developed for providers by providers. CEP supports fully the use of the CORE Back Tool by providers, educators, decision makers and others. Please note the following information prior to use of CORE Back Tool to ensure appropriate permission is sought and reference used.

Disclaimer:

This Tool was developed for licensed health care professionals in Canada as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool. Neither the Centre for Effective Practice (“CEP”), the Canadian Spine Society, the Nurse Practitioners’ Association of Ontario, The College of Family Physicians of Canada, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any external sources referenced in this Tool (whether specifically named or not) that are owned or operated by third parties, including any information or advice contained therein.


Creative Commons License:

The CORE Back Tool is a product of the Centre for Effective Practice under copyright protection with all rights reserved to the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the preceding paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the CORE Back Tool for commercial purposes or any modifications of the tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: [email protected]).

For statistical and bibliographic purposes, please notify the Centre for Effective Practice ([email protected]) of any use or reprinting of the tool. Please use the below citation when referencing the tool:

This Tool was developed for licensed health care professionals in Canada as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool. Neither the Centre for Effective Practice (“CEP”), the Canadian Spine Society, the Nurse Practitioners’ Association of Ontario, The College of Family Physicians of Canada, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any external sources referenced in this Tool (whether specifically named or not) that are owned or operated by third parties, including any information or advice contained therein.

Reprinted with Permission from Centre for Effective Practice (February 2016). CORE Back Tool. Toronto. Centre for Effective Practice.