Development of a Person-Centred Coordinated Care Pathway in Swedish Healthcare for Low Back Pain

Allan Abbott; Malin Forsbrand; Thomas Torstensson; Ann-Charlotte Lindström; Gudrun Greim; Sammy Klaff; Åsa Niper; Marc Karlsson; Christian Simonsberg; Mimmi Engström; Tommy Olsson; Annelie Petersson; Per Ekman; Peter Försth; Gösta Ullmark; Steven J. Linton

doi:10.5334/ijic.8940

Development of a Person-Centred Coordinated Care Pathway in Swedish Healthcare for Low Back Pain

International Journal of Integrated Care

Volume 25 (2025): Issue 2

By: Allan Abbott , Malin Forsbrand , Thomas Torstensson , Ann-Charlotte Lindström, Gudrun Greim, Sammy Klaff, Åsa Niper , Marc Karlsson, Christian Simonsberg, Mimmi Engström, Tommy Olsson, Annelie Petersson, Per Ekman, Peter Försth, Gösta Ullmark and Steven J. Linton

Open Access

|May 2025

Abstract

Introduction: This project aimed to develop a Person-Centred Co-ordinated Care (P3C) pathway for low back pain (LBP).

Description: A national working group was formed consisting of representatives from all regional healthcare organisations in Sweden and included all relevant healthcare professions, academia, and patient organisations. A mixed method iterative design and consensus approach was applied in the development of the P3C pathway.

Discussion: As a foundation, patient interviews along with a review of literature were conducted investigating the evidence base for healthcare interventions, earlier regional care programs/pathways and guidelines in Sweden as well as patient experiences and challenges with healthcare for LBP. Updated evidence-based clinical recommendations, tools supporting the practical use of the national P3C pathway and national healthcare data registry-based quality outcome indicators were then developed. Thereafter, an open consultation period provided review and feedback for final revisions and consensus.

Conclusions: Essential factors for integrating best praxis according to scientific evidence and patient and healthcare professional perspectives were identified to establish a Swedish national P3C pathway for LBP. This provides a novel and innovative example of feasible methodology applicable in the international context. Future research will evaluate potential improvements in healthcare quality outcomes and effectiveness of dissemination and implementation strategies.

References

Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine (Phila Pa 1976). 2008 Jan 1;33(1):95–103. DOI: 10.1097/BRS.0b013e31815e7f94
Open DOI Search in Google Scholar Back to article
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016. Lancet. 2017;390:1211–1259. DOI: 10.1016/S0140-6736(17)32154-2
Open DOI Search in Google Scholar Back to article
Jöud A, Petersson IF, Englund M. Low back pain: epidemiology of consultations. Arthritis Care Res (Hoboken). 2012 Jul;64(7):1084–8. DOI: 10.1002/acr.21642
Open DOI Search in Google Scholar Back to article
Olafsson G, Jonsson E, Fritzell P, Hägg O, Borgström F. Cost of low back pain: results from a national register study in Sweden. Eur Spine J. 2018 Nov;27(11):2875–2881. DOI: 10.1002/acr.21642
Open DOI Search in Google Scholar Back to article
Sheaff R, Halliday J, Øvretveit J, Byng R, Exworthy M, Peckham S, et al. Integration and continuity of primary care: polyclinics and alternatives – a patient-centred analysis of how organisation constrains care co-ordination. Southampton, UK: NIHR Journals Library; 2015 Aug. DOI: 10.3310/hsdr03350
Open DOI Search in Google Scholar Back to article
Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. Lancet. 2018 Jun 9;391(10137):2384–2388. DOI: 10.1016/S0140-6736(18)30488-4
Open DOI Search in Google Scholar Back to article
Locock L. Healthcare redesign: meaning, origins and application. Qual Saf Health Care. 2003 Feb;12(1):53–7. DOI: 10.1136/qhc.12.1.53
Open DOI Search in Google Scholar Back to article
Womack J, Jones D. From lean production to the lean enterprise. Harvard Business Rev. 1994:93–104. [cited 2024 26 Jun]. Available from: https://hbr.org/1994/03/from-lean-production-to-the-lean-enterprise
Search in Google Scholar Back to article
Plsek P, Wilson T. Complexity, leadership and management in healthcare organisations. BMJ. 2001;323:746–9. DOI: 10.1136/bmj.323.7315.746
Open DOI Search in Google Scholar Back to article
Deming WE. Out of the crisis: quality productivity and the competitive position. Cambridge: Mass. MIT Press, 1986.
Search in Google Scholar Back to article
Berwick D. Sounding board: Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53–6. DOI: 10.1056/NEJM198901053200110
Open DOI Search in Google Scholar Back to article
Batalden PB, Stoltz PK. A framework for the continual improvement of health care: building and applying professional and improvement knowledge to test changes in daily work. Jt Comm J Qual Improve. 1993;19:424–51. DOI: 10.1016/s1070-3241(16)30025-6
Open DOI Search in Google Scholar Back to article
Hammer M, Champy J. Reengineering the corporation: a manifesto for business transformation. New York: Brealey, 1993.
Search in Google Scholar Back to article
Phelan A, Rohde D, Casey M, Fealy G, Felle P, O’Kelly G, et al. Co-Creating Descriptors and a Definition for Person-Centred Coordinated Health Care: An Action Research Study. Int J Integr Care. 2021 Mar 3;21(1):11. DOI: 10.5334/ijic.5575
Open DOI Search in Google Scholar Back to article
Lloyd HM, Pearson M, Sheaff R, Asthana S, Wheat H, Sugavanam TP, et al. Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care. Health Res Policy Syst. 2017 Nov 22;15(1):98. DOI: 10.1186/s12961-017-0263-z
Open DOI Search in Google Scholar Back to article
Swedish Council of Local Authorities and Regions. National system for knowledge-based management [cited 2024 Nov 11]. Available from: https://skr.se/skr/halsasjukvard/utvecklingavverksamhet/systemforkunskapsstyrning.48276.html.
Search in Google Scholar Back to article
Fullen B, Morlion B, Linton SJ, Roomes D, van Griensven J, Abraham L, et al. Management of chronic low back pain and the impact on patients’personal and professional lives: Results from an international patient survey. Pain Practice. 2022;00:1–15. DOI: 10.1111/papr.13103
Open DOI Search in Google Scholar Back to article
Lim YZ, Chou L, Au RTM, Seneviwickrama KLMD, Cicuttini FM, Briggs AM, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. Journal of Physiotherapy. 2019;65:124–135. DOI: 10.1016/j.jphys.2019.05.010
Open DOI Search in Google Scholar Back to article
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health. 2019;11(4):589–597. DOI: 10.1080/2159676X.2019.1628806
Open DOI Search in Google Scholar Back to article
Stelfox HT, Straus SE. Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation. J Clin Epidemiol. 2013a Dec;66(12):1328–37. DOI: 10.1016/j.jclinepi.2013.05.017
Open DOI Search in Google Scholar Back to article
Stelfox HT, Straus SE. Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development. J Clin Epidemiol. 2013b Dec;66(12):1320–7. DOI: 10.1016/j.jclinepi.2013.05.018
Open DOI Search in Google Scholar Back to article
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007 Feb 15;7:10. DOI: 10.1186/1471-2288-7-10
Open DOI Search in Google Scholar Back to article
Low back pain, person centered coordinated care pathway support material [cited 2024 Jun 26]. Available from: https://kunskapsstyrningvard.se/kunskapsstyrningvard/kunskapsstod/publiceradekunskapsstod/rorelseorganenssjukdomar/vardforlopplandryggsbesvar.73325.html
Search in Google Scholar Back to article
1177 knowledge support for health care personnel – Low back pain, person centered coordinated care pathway. [cited 2024 Jun 26]. Available from: https://vardpersonal.1177.se/kunskapsstod/vardforlopp/landryggsbesvar-hos-vuxna/
Search in Google Scholar Back to article
Määttä S, Petersson C, Gäre BA, Henriks G, Ånfors H, Lundberg C, Nilsagård Y. Experiences of co-producing person-centred and cohesive clinical pathways in the national system for knowledge-based management in Swedish healthcare: a qualitative study. Res Involv Engagem. 2024 Jun 7;10(1):55. DOI: 10.1186/s40900-024-00565-3
Open DOI Search in Google Scholar Back to article
Hoque DME, Kumari V, Hoque M, Ruseckaite R, Romero L, Evans SM. Impact of clinical registries on quality of patient care and clinical outcomes: A systematic review. PLoS One. 2017 Sep 8;12(9):e0183667. DOI: 10.1371/journal.pone.0183667
Open DOI Search in Google Scholar Back to article
Fraussen B, Albareda A, Braun C. Conceptualizing consultation approaches: identifying combinations of consultation tools and analyzing their implications for stakeholder diversity. Policy Sci. 2020;53:473–493. DOI: 10.1007/s11077-020-09382-3
Open DOI Search in Google Scholar Back to article
WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
Search in Google Scholar Back to article
Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskeletal Disord. 2024 May 1;25(1):344. DOI: 10.1186/s12891-024-07468-0
Open DOI Search in Google Scholar Back to article
Corp N, Mansell G, Stynes S, Wynne-Jones G, Morso L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021 Feb;25(2):275–295. DOI: 10.1002/ejp.1679
Open DOI Search in Google Scholar Back to article
Coeckelberghs E, Verbeke H, Desomer A, Jonckheer P, Fourney D, Willems P, et al. International comparative study of low back pain care pathways and analysis of key interventions. Eur Spine J. 2021 Apr;30(4):1043–1052. DOI: 10.1007/s00586-020-06675-2
Open DOI Search in Google Scholar Back to article
NSW Agency for Clinical Innovation. Model of care for the management of low back pain – Summary. Sydney: ACI; 2024. [cited 2024 Jun 26]. Available from: https://www.sira.nsw.gov.au/__data/assets/pdf_file/0020/1280063/Model-of-care-for-the-management-of-low-back-pain-Summary.pdf
Search in Google Scholar Back to article
Vårdförlopp undergräver gott omdöme och personligt ansvar. [Care pathways undermine good judgment and personal responsibility]. Läkartidningen. 2020;117:FYM7 [in Swedish]. [cited 2024 Jun 26]. Available from: https://lakartidningen.se/opinion/debatt/2020/03/standardiserade-vardforlopp-undergraver-bade-gott-omdome-och-personligt-ansvar/
Search in Google Scholar Back to article
Cizinsky S, Järhult B, Lundell P, Wingstrand H. Fundamentet i läkargärningen riskerar att avskaffas. [The foundation of the medical profession is at risk of being abolished]. Läkartidningen. 2019,116:FWSC [in Swedish]. [cited 2024 Jun 26]. Available from: https://lakartidningen.se/opinion/debatt/2019/12/fundamentet-i-lakargarningen-riskerar-att-avskaffas/
Search in Google Scholar Back to article
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999 Feb 20;318(7182):527–30. DOI: 10.1136/bmj.318.7182.527
Open DOI Search in Google Scholar Back to article
Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008 Oct 6;337:a1714. DOI: 10.1136/bmj.a1714
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/ijic.8940 | Journal eISSN: 1568-4156

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Language: English

Submitted on: Jun 26, 2024

Accepted on: May 2, 2025

Published on: May 9, 2025

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

person-centred,

care pathway,

low back pain

© 2025 Allan Abbott, Malin Forsbrand, Thomas Torstensson, Ann-Charlotte Lindström, Gudrun Greim, Sammy Klaff, Åsa Niper, Marc Karlsson, Christian Simonsberg, Mimmi Engström, Tommy Olsson, Annelie Petersson, Per Ekman, Peter Försth, Gösta Ullmark, Steven J. Linton, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 25 (2025): Issue 2