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PURPOSE: The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. METHODS: The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. RESULTS: The areas of immediate concern were "Aging spine," "Future of spine care," "Spinal cord injuries," "Children and adolescent spine," "Spine-related disability," "Spine Educational Standards," "Patient safety," and "Burden on economy." Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10-11, 2020 held from the G20 platform. CONCLUSIONS: This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.

Sara Elli,1 Diego Contro,1 Silvana Castaldi,2,3 Marco Fornili,4 Ilaria Ardoino,4 Antonello V Caserta,5 Lorenzo Panella5 1Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy; 2Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; 3Health Management Department, Fondazione IRCCS Ca’ Granda OMP, Milan, Italy; 4Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 5Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini – CTO, Milan, Italy Purpose: The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient’s health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.Patients and methods: We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient’s caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.Results: Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland–Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.Conclusion: This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered p