Clinical Treatment Pathway and Decision Support for Treatment of Acute Uncomplicated Low Back Pain

Acute uncomplicated low back pain is a very common problem in the United States. Acute low back pain is defined as pain present for up to 6 weeks. There is significant variability in the approach and treatment of acute uncomplicated low back pain and unnecessary/inappropriate diagnostic studies and treatments are common. Healthcare providers need a specific evidence-based clinical pathway to increase diagnostic accuracy and improve the development of treatment plans that will lead to improved outcomes. The first objective of this project was to develop an evidence-based clinical decision support pathway and algorithm to improve assessment and management of acute low back pain. The second objective of this project was to disseminate this information to providers by authoring a scholarly article for publication consideration in the Journal of the American Academy of Nurse Practitioners. The project objectives were met by the development of a treatment pathway and decision support algorithms. Utilization of the clinical pathway and decision support algorithm will lead to decreased over utilization of diagnostic measures and treatments. Use of the pathway will also improve diagnostic accuracy of spine related conditions. The clinical pathway and algorithm also serve as a guide for training new healthcare providers who wish to improve knowledge and understanding regarding diagnosis and treatment of acute low back pain. The pathway assists providers in presenting treatment options utilizing a shared decision making format. The clinical algorithm was developed to facilitate appropriate use of the pathway. The pathway and algorithm were presented in a scholarly article submitted for publication consideration to the American Academy of Nurse Practitioners. The Academic Center for Excellence (ACE) Star Model of Knowledge Transformation (2004) was selected as the theoretical framework for this project. This model helps to clarify the cycles and characteristics of knowledge that are used in evidence-based practice. It helps to organize existing information as well as newly understood concepts that are designed to improve care in the clinical setting. The Star Model of Knowledge Transformation depicts the relationship between the various phases of knowledge transformation from the discovery of new knowledge through integration into practice and subsequent evaluation of new practices. The Essentials of Doctoral Education for Advanced Practice Nurses (2006) are made up of a number of key elements, many of which were integrated and used to guide this project. Included in this project were Essentials I. II, III, VII and VIII. DNP Essential I provided an emphasis on patient education and shared decision-making. This project was chosen to improved access to care in the hopes that outcomes could be improved. Nurses are in a unique position to improve this process and facilitate positive change which satisfies the second DNP Essential. The criterion for the third DNP Essential is the process which focuses mainly on the clinical scholarship and analytical methods of evidence based practice. DNP Essential VII, clinical prevention and population for improving the nation's health was addressed. Lastly, DNP Essential VIII, advanced nursing practice, was supported and met by improving education and experience of the advanced practice clinician in the area of acute uncomplicated low back pain.