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Mar 2016

Low Back Pain


Improving the quality of treatment can make a life-changing difference to patients suffering from low back pain. Recognize common mechanical back pain syndromes and screen for conditions where management may include investigations, referral and specific medications using the Clinically Organized Relevant Exam (CORE) Back Tool and toolkit.

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In The Know: Low Back Pain

Our video on the CORE Back Tool, featuring Dr. Julia Alleyne, with information about how our tool has been updated and how it can support primary care providers in better managing patients with low back pain. Visit:


Electronic Medical Record Resources


About the tool

The Centre for Effective Practice (CEP) has developed tools and education modules to help primary care physicians and nurse practitioners better manage patients who suffer from low back pain. This work builds from the Ministry of Health and Long-Term Care (MOHLTC) Low Back Pain Strategy, which began in 2012. The goal of this initiative was to reduce the number of unnecessary diagnostic tests, improve wait times, and enhance patient care. To read more about the provincial strategy click here.

Feedback from primary care providers about the CORE Back Tool 2012 informed revisions to a 2016 update. Providers told us they wanted more information about the evidence, an expansion of the initial management options, more clearly integrated patient key messages, and improvements to the overall information flow to align with their decision-making processes. CORE Back Tool 2016 contains these the following features:

  • New cover page with teaching pearls to support those using the CORE Back Tool for education and/or to support new users.
  • Integration of identification of the mechanical patterns for low back pain into patient history questions.
  • Revised psychosocial yellow flags section, which includes questions and hints for providers to help identify patients who are at higher risk for chronic problems.
  • Patient key messages integrated throughout the tool.
  • Management Matrix with suggestions for initial office management based on the patterns of low back pain.

CEP was engaged to develop and deliver the provincial provider education that included the original CORE Back Tool, 2012. To read more about the provider education click here. In 2015/16, Centre for Effective Practice invested funds to update the CORE Back Tool to reflect provider feedback and recent evidence.

The CORE Back Tool 2016 was developed using Centre for Effective Practice’s integrated knowledge translation approach. The development process included an evidence review, expanded references and integration of expert input for areas where there is a lack of evidence but where primary care providers need a recommended approach. CEP ensures that healthcare providers are engaged throughout the tool development process, using a user-centered design methodology to test the usability of tools from a provider perspective.

Engaging Providers in the Update
The CEP team led a number of activities to include the experience of providers who had used the Tool in the CORE Back Tool 2016 Update. We gathered input from:

  • Review of evaluation data from our online Primary Care Focus on Low Back Pain course on the CORE Back Tool (over 5000 providers participated in the online course).
  • Results from a survey of primary care providers on the usability of the CORE Back Tool 2012 version.
  • Heuristics evaluation to improve flow of information.
  • One-on-one user centered interviews with primary care providers.
  • Engagement with our Clinical Working Group.

The findings from these activities build on the extensive provider engagement activities used to develop the first CORE Back Tool, which included three focus groups with Family Physicians and Nurse Practitioners from across Ontario.

Participants in the 2012 and 2016 projects were recruited through CEP’s quarterly updates.

The Centre for Effective Practice worked with a clinical lead and clinical working group and enlisted expert input for the 2016 version.

Clinical leads

  • Julia Alleyne


    Dr. Julia Alleyne is a family physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an associate clinical professor. 

    In 2009, she completed her Masters with a focus in Health Professions Education. Since that time, she has been active as an educational curriculum consultant including acting as the clinical lead for Ontario’s Low Back Pain Strategy and program designer for the MSK Initiative in British Columbia. In 2013, she was appointed as the first Family Physician to be chair of Bone and Joint Canada. 

    In addition, Dr. Alleyne’s work in the area of back care includes being an educational consultant for curriculum and tool development for provincial MSK initiatives in Ontario and British Columbia. She has co-authored a series of spine related articles for Current Concepts in Care and is the co-chair for the Spine Quality Based Pathway. Dr. Alleyne has worked with the Centre for Effective Practice for a decade in the area of Primary Care Musculoskeletal tool development and education.

Education Planning Committee

For the 2016 update, we invited members from the CORE Back Tool 2012 Education Planning Committee to participate. In 2016, membership was expanded to include the following:

  • Michelle Acorn, Nurse Practitioner
  • John Axler, Family Physician
  • Craig Bauman, Chiropractor
  • Kerri Deir, Kinesiologist
  • David Dos Santos, Chiropractor
  • Dale Guenter, Family Physician
  • Bruce Hobson, Family Physician
  • Jessica Munro, Nurse Practitioner
  • Steve Radke, Family Physician
  • Hema Rajawat, Pharmacist
  • Inge Schabort, Family Physician
  • Murray Townsend, Chiropractor
  • Kathy Tripp, Nurse Practitioner
  • Xu Wang, Family Physician
  • Jennifer Young, Family Physician

Thank you to all of our members for their work!

Expert Reviewers

CEP sought additional expert input for the 2016 version on topics including: terminology, assessment, management and appropriate referrals. Expert input was provided by:

  • Hamilton Hall


    Dr. Hamilton Hall is a Professor in the Department of Surgery at the University of Toronto and on the orthopaedic staff at the Sunnybrook Health Sciences Centre.

    ​​​​​​​In 1974 Dr. Hall founded the Canadian Back Institute (CBI Health Group), now the largest rehabilitation company in Canada. Dr. Hall continues to serve as its Medical Director. He is a co-founder of the Canadian Spine Society and is presently the Society’s Executive Director.

    Dr. Hamilton Hall is a member of the North American Spine Society, the Canadian Orthopaedic Association and the International Society for the Study of the Lumbar Spine. He has served on the editorial boards of Spine, The Spine Journal and The BackLetter. In addition to over 100 published articles and book chapters and 1000 invited presentations, Dr. Hamilton Hall is the author of the best-selling Back Doctor series, most recently A Consultation with the Back Doctor.

  • Dr. Raja Rampersaud


    Dr. Rampersaud is nationally and internationally recognized leader and innovator in minimally invasive spine surgery. Dr. Rampersaud has recently completed a two year term as the president of the Canadian Spine Society and has been instrumental in the development of spine care advocacy efforts across Canada. Dr. Rampersaud is leading the Interprofessional Spine Assessment and Education Centre (ISAEC) Pilot Project funded through Government of Ontario.



Through individual participation in the development process, the Canadian Spine Society (CSS) and the Nurse Practitioners’ Association of Ontario (NPAO) provided endorsements for the CORE Back Tool 2016. The CEP is pleased to have an organization-level endorsement from the College of Family Physicians of Canada (CFPC).

If you would like to be engaged in and/or endorse the CORE Back Tool or if you are interested in collaborating, modifying or using the toolkit for commercial purposes, contact us at

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