Presentation of the cost action B13


Mihail Pascu

COST OFFICE, 149 Av. Louise, P;O; BOX 12, 1050, Brussels, E-mail:


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 1993 in Sweden, low back pain caused 25% of the total number of sick leaves


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