{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:29:22Z","timestamp":1782304162275,"version":"3.54.5"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Choosing Wisely Alberta"},{"name":"Canadian Chiropractic Research Fund"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Family physicians in Canada\u2019s universal healthcare system often manage low back pain patients using interventions not recommended in clinical guidelines, such as pharmaceuticals, imaging and spinal injections, while guideline-based treatments like education and exercise remain unfunded. The Alberta Back Care pathway was developed to address this gap, offering funded, evidence-based care for low back pain patients in 5 streams (acute, sub-acute, chronic, chronic non-responsive and stable radiculopathy).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate the feasibility of implementing the pathway in two urban Primary Care Networks in Alberta, Canada.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Each of the 5 pathway streams provided physicians with information scripts, no-cost interventions (pharmaceuticals and otherwise) and interventions to avoid. From April 2021 to November 2023, the RE-AIM framework was used to assess implementation feasibility of the pathway.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>For the RE-AIM dimension of reach, 25% (n = 41\/162) of eligible family physicians in Primary Care Network \u201cA\u201d and 12% (n = 26\/221) in Primary Care Network \u201cB\u201d enrolled in the study. Over half of enrolled physicians (n = 21\/41 and 21\/26) referred at least one patient with most referrals to the GLA:D Back program for chronic low back pain stream (93% in network \u201cA\u201d and 88% in network \u201cB\u201d). Implementation, evaluated as the proportion of referrals by physician compared to their total low back pain caseload, was low (&gt; 0\u201310% referred) for 52% (n = 11\/21) of physicians in network \u201cA\u201d, and medium-low (10\u201325% referred) for 52% (n = 11\/21) of physicians in network \u201cB\u201d. The number of pathway-appropriate patients in each physician\u2019s caseload was unknown. Maintenance at 12 months was 56% (n = 10\/18) in network \u201cA\u201d and 39% (n = 7\/18) in network \u201cB\u201d.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The Alberta Back Care pathway was feasible to implement during the pandemic and primarily serving patients with chronic low back pain by providing access to a guideline-based education and exercise group program (GLA:D Back).<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0312737","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T18:31:32Z","timestamp":1732732292000},"page":"e0312737","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Alberta Back Care Pathway: The feasibility of implementing a novel care pathway to improve low back pain management for family physicians in primary care"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1104-0902","authenticated-orcid":true,"given":"Brandyn","family":"Powelske","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-6038","authenticated-orcid":true,"given":"Alice","family":"Kongsted","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyson","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9487-1779","authenticated-orcid":true,"given":"Gregory","family":"Kawchuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"pone.0312737.ref001","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/art.34347","article-title":"A systematic review of the global prevalence of low back pain","author":"D Hoy","year":"2012","journal-title":"Arthritis and Rheumatism"},{"key":"pone.0312737.ref002","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"T Vos","year":"2017","journal-title":"Lancet"},{"key":"pone.0312737.ref003","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"J Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"pone.0312737.ref004","doi-asserted-by":"crossref","first-page":"1098100","DOI":"10.3389\/fpubh.2023.1098100","article-title":"Global and regional estimates of clinical and economic burden of low back pain in high-income countries: a systematic review and meta-analysis","volume":"11","author":"F Fatoye","year":"2023","journal-title":"Front Public Health"},{"key":"pone.0312737.ref005","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1136\/annrheumdis-2013-204428","article-title":"The global burden of low back pain: estimates from the Global Burden of Disease 2010 study","volume":"73","author":"D Hoy","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"pone.0312737.ref006","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1097\/01.brs.0000231771.14965.e4","article-title":"A population-based survey of back pain beliefs","volume":"31","author":"DP Gross","year":"2006","journal-title":"Canada. 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