Design of a web-based clinical decision support system for guiding patients with low back pain to the best next step in primary healthcare

Low back pain (LBP) is the most common cause for activity limitation and has a tremendous socioeconomic impact in Western society. In primary care, LBP is commonly treated by general practitioners (GPs) and physiotherapists. In the Netherlands, patients can opt to see a physiotherapist without referral from their GP (so called ‘self-referral’). Although self-referral has improved the choice of care for patients, it also requires that a patient knows exactly how to select the best next step in care for his or her situation, which is not always evident. This paper describes the design of a web-based clinical decision support system (CDSS) that guides patients with LBP in making suitable choices on self-referral. We studied literature and guidelines on LBP and conducted semi-structured interviews with 3 general practitioners and 5 physiotherapists on the classification of LBP with respect to the best next step in care: visit a GP, visit a physiotherapist or perform self-care. The interview results were validated by means of an online survey, which resulted in a select group of key classification factors. Based on the results, we developed an ontology and a decision tree that models the decision making process of the CDSS.