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Parcours de soins pour les lombalgies

Date de la dernière mise à jour : février 2024

Shared Decision-making (SDM)

Clinical Cornerstone:

  • Shared Decision Making (SDM) is a vital component of patient-centered care, especially in managing conditions like LBP, where various treatment options exist. This collaborative process involves clinicians, patients, and their families working together, aligning healthcare decisions with the best available evidence, and considering the patient's values, preferences, and circumstances.

Steps in Shared Decision Making:

1. Introduce the Decision: Explain the need for a decision regarding LBP management and emphasize the value of the patient's input.

2. Present the Options: Detail the available treatment options, discussing the benefits, risks, and uncertainties of each.

3. Discuss Patient Values and Preferences: Explore what is most important to the patient, including their goals, concerns, lifestyle factors, and cultural or personal beliefs that may influence their decision. Can use patient decision aids if available, e.g. https://decisionaid.ohri.ca/AZsearch.php?criteria=low+back+pain.

4. Deliberation: Facilitate a discussion where the patient can consider the pros and cons of each option, encouraging them to ask questions and express any concerns.

5. Decision: Reach a decision that reflects a consensus between the clinician and the patient, based on evidence and patient's preferences. Obtain informed consent to proceed with the agreed upon plan.

6. Review and Re-evaluate: Plan for regular follow-ups to assess the effectiveness of the selected management plan and adjust as necessary.

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

Non-specific LBP or LBP with radiculopathy:

  • Education

  • Self-care

  • Exercise

  • Manual therapy

  • Medicines

  • Psychological therapy

  • Social support

  • Mind-body interventions

  • Needling therapies, electrotherapies*

  • Mobility assistive devices

  • Multicomponent biopsychosocial care

  • Topical ceyenne pepper

Additionally for LBP with radiculopathy:

  • Medical/surgical consultations

Other specific LBP:

  • Refer to appropriate emergency or healthcare provider

Major symptom/sign change

Goals not achieved

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

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