Presentation of the
cost action B13
Mihail Pascu
COST OFFICE, 149
Av. Louise, P;O; BOX 12, 1050, Brussels, E-mail: mpascu@cost.esf.org
The COST ACTION B13 entitled Low back pain: guidelines for its
management is an European research network dedicated
to exchange of data, results and knowledge in the field of low back pain (LBP),
within which scientists from 14 European countries (Austria, Belgium, Denmark,
Finland, France, Germany, Israel, Italy, Netherlands, Norway, Spain, Sweden,
Switzerland, United Kingdom) worked between September 1999 and September 2004
to reach the objectives approved for the network by the COST Committee of
Senior Officials
According to the Technical Annex of the ACTION B13, in industrialised
countries, LBP is the main cause of public expense in terms of medical care and
work absenteeism; up to 80% of the population reports having suffered from it
at some time in their lives. The expenses generated in Holland, for instance,
in 1991 represented 1,7% of the Gross Domestic Product, and in
The networking activities were developed by the COST ACTION B13 based on
the individual work of the research groups members in
the ACTION as well as on 15 meetings of its Management Committee (MC) and 35
meetings of the Working Groups (WG) established by the MC. The total number of
participants (medical doctors, medical physics specialists, psychologists,
psychiatrists, physiotherapists, etc) in the MC and WG meetings was 60
The approximate total cost of the projects carried out under the network
and financed from National or other resources was € 9M (calculated at 1998
prices). The COST injection of funds in meetings hold be the COST ACTION B13
amounted in total € 350,000 out of which € 90,000in 2004
The main goal of this network, was to implement management guidelines for
acute and chronic LBP. These guidelines include the guidelines of the work
previously carried out at local or national levels and
combine those procedures that have proved scientifically effective for the
prevention, diagnosis, treatment or rehabilitation of LBP (or have, at least,
the consensus of specialists where this evidence does not exist), in order to
improve the quality of the medical care received by European patients
This programme neither quantifies the costs of LBP in Europe nor describes its present management. Rather, it implements
guidelines for LBP optimum clinical management based on the existing scientific
evidence, in order to disseminate the guidelines and introduce them into daily
clinical practice
The network objectives were conceived to contribute to: help clinicians to
base their decisions on scientific evidence; improve the results of medical
care; justify the expense generated by this problem, by means of a more
rational and efficient use of resources; meet existing European norms regarding
the safety and effectiveness standards requested by European patients in all
procedures and treatments they undergo; identify the areas in which scientific
evidence is lacking, in order to define priority research
areas
The scientific programme, according to the Technical Annex of the ACTION B13 contained the following main elements :
1. Definition of the minimum standards of scientific quality applicable in
the evaluation of the preventive, diagnostic, and therapeutic procedures to be
studied throughout the programme. The standards used in existing guidelines
were considered for this purpose
2. Identification and collection of scientific studies on preventive, diagnostic and therapeutic procedures
compliant with the established quality criteria, that have not been
included in previous guidelines due to reasons other than their scientific
quality
3. Definition of: – categories for
the quality of the evidence on which scientific studies are classified, according to their methodology and consistency; – categories for the recommendations derived
from that evidence (ranging from
advising the use of a particular procedure to recommending its disuse)
4. Classification of the identified procedures within the defined
categories
5. Establishment of preventive, diagnostic and therapeutic strategies. The
specification – if the available scientific evidence allows it – of criteria for clinical adequacy and the ideal
conditions for utilisation of each procedure
6. Definition of the areas in which scientific evidence is scarce, of
low quality or contradictory, in order
to identify priority research areas in this field
7. Writing of the final report and of clinical management guidelines for
low back pain
8. Dissemination of the guidelines, as extensively as possible, with
and among those who provide health care
to patients with LBP in COST countries.
The ultimate targets of the network were the following :
- Health professionals who provide health care to patients with LBP
- Administrative and health authorities
- Patients.
The Working Groups defined by the MC had the following main scientific tasks :
- To evaluate the minimum standards of scientific quality applicable to the preventive,
diagnostic and therapeutic procedures, considering the standards used for the
elaboration of the existing guidelines
- To collect all the scientific studies on preventive, diagnostic and therapeutic procedures used in practice for
LBP, that have been disregarded in
previous guidelines for reasons other than their scientific quality
- To establish categories based on the study, selection, and/or summary of
those defined by previously elaborated guidelines
- To produce clinical management guidelines for acute and chronic LBP, based on one or several of the existing
ones, and incorporating
the recommendations of the Working Groups constituted within the
COST ACTION B13