{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:07:30Z","timestamp":1780639650845,"version":"3.54.1"},"reference-count":45,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,12]],"date-time":"2022-11-12T00:00:00Z","timestamp":1668211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Low back pain (LBP) is the leading cause of disability worldwide and has an excessive societal burden. Accumulating evidence has shown that some medical approaches such as imaging in absence of clear indications, medication and some invasive treatments may contribute to the problem rather than alleviating it.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the extent of de\u2010implementation of non\u2010evidence\u2010based hospital treatments for LBP care in the Netherlands in the last three decades.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a register\u2010based population\u2010level observational study with Dutch hospital data, providing a nearly complete coverage of hospital admissions in the Netherlands in 1991\u20132018, we assessed five frequently applied non\u2010evidence\u2010based hospital treatments for LBP. Time trends in treatment use (absolute and per 100,000 inhabitants) were plotted and analysed using Poisson regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The use of bed rest for non\u2010specific LBP and hernia nuclei pulposi, and discectomy for spinal stenosis decreased 91%, 81% and 86% since the availability of evidence\/guidelines, respectively. De\u2010implementation, beyond 84%, was reached after 18 and 17\u2009years for bed rest for non\u2010specific LBP and discectomy respectively, while it was not reached after 28\u2009years for bed rest for hernia nuclei pulposi. For spinal fusion and invasive pain treatment, there was an initial increase followed by a reduction. Overall, these treatments reduced by 85% and 75%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the Netherlands, de\u2010implementation of five non\u2010recommended hospital LBP treatments, if at all, took several decades. Although de\u2010implementation was substantial, slow de\u2010implementation has likely resulted in considerable waste of resources and avoidable harm to many patients in Dutch hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Medically intensive approaches to low\u2010back pain care contribute to the high societal burden of this disease. There have been calls to avoid such care. Using Dutch hospital data, we showed that de\u2010implementation of five non\u2010recommended hospital low\u2010back pain treatments, if at all, took several decades (i.e. \u226517\u2009years) after availability of evidence and guidelines. Slow de\u2010implementation has likely resulted in considerable waste of resources and avoidable harm to hospital patients; better ways for de\u2010implementation of non\u2010evidence\u2010based care are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.2052","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T10:15:22Z","timestamp":1667297722000},"page":"212-222","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The slow de\u2010implementation of non\u2010evidence\u2010based treatments in low back pain hospital care\u2014Trends in treatments using Dutch hospital register data from 1991 to 2018"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4034-7063","authenticated-orcid":false,"given":"Pieter","family":"Coenen","sequence":"first","affiliation":[{"name":"Department of Public and Occupational Health, Amsterdam UMC Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"de Wind","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, Amsterdam UMC Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"van de Ven","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"de Maaker\u2010Berkhof","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, Amsterdam UMC Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Koes","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense Denmark"},{"name":"Department of General Practice, Erasmus MC University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle","family":"Buchbinder","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine, Monash University  Melbourne Australia"},{"name":"Monash Department of Clinical Epidemiology Cabrini Health  Malvern Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hartvigsen","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense Denmark"},{"name":"Chiropractic Knowledge Hub  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes (Han) R.","family":"Anema","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, Amsterdam UMC Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.ED000032"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742\u20106723.13941"},{"key":"e_1_2_10_4_1","first-page":"65","article-title":"Managing clinical knowledge for health care improvement","volume":"1","author":"Balas E. 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