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Irish Journal of Medical Science (1971 -)
Published in: Irish Journal of Medical Science (1971 -) 4/2013

01-12-2013 | Original Article

The role of clinical specialist Physiotherapists in the management of low back pain in a Spinal Triage Clinic

Authors: S. Murphy, C. Blake, C. K. Power, B. M. Fullen

Published in: Irish Journal of Medical Science (1971 -) | Issue 4/2013

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Abstract

Background

Traditional care pathways for patients with low back pain (LBP) where general practitioners (GPs) refer to consultant specialists can lead to excessive waiting times for patients and questionable use of health care resources. The evaluation of more cost effective pathways is a priority.

Aims

The study aims to determine if clinical specialist physiotherapists can allocate patients into the three distinct diagnostic triage categories in line with international guidelines. A secondary aim is to examine the utility of baseline domains to inform clinical decision making.

Methods

A review of LBP patients (n = 1,532) consecutively referred between 2008 and 2010 to a physiotherapy led spinal triage clinic was undertaken. Baseline demographics, pain severity (Visual Analogue Scale), disability (Roland Morris Disability Questionnaire), distress (Distress and Risk Assessment Method), mobility and function were assessed. Relationships between these factors were analysed.

Results

Eighty-five percent of the population were deemed suitable for conservative management and were referred for either group exercise intervention (n = 1,125, 73 %) or individual treatment (n = 178, 12 %), in line with clinical guidelines. Fourteen percent were discharged and only 1 % required a specialist opinion. Patients allocated to the three management streams could be clearly discriminated by baseline measures of pain, distress, disability and function (p < 0.01).

Conclusion

Clinical Specialist physiotherapists are effective in assessing and selecting appropriate care pathways for LBP patients in line with international LBP clinical guidelines. The utility of the physical and psychological measures to differentiate between groups of varying clinical severity has important implications for treatment selection and management.
Literature
1.
Goubert L, Crombez G, Van Damme S (2004) The role of neuroticism, pain catastrophizing and pain-related fear in vigilance to pain: a structural equations approach. Pain 4(107):234–241CrossRef
2.
Fullen BM, Hurley DA, Power CK, Canavan D, O’Keeffe D (2006) The need for a pain management strategy in Ireland. Ir J Med Sci 175(2):68–73PubMedCrossRef
3.
4.
Department of Health and Children Health (2007) statistics available at dohc.ie, accessed August 8th 2012
5.
6.
Pearse E, Maclean A, Ricketts D (2006) The extended scope physiotherapist in orthopaedic out-patients—an audit. Ann R Coll Surg Engl 88:653–655PubMedCrossRef
7.
Oldmeadow L, Bedi S, Burch H et al (2007) Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. Med J Aust 186:625–628PubMed
8.
Doocey A, Reddy W (2010) Integrated care pathways the touchstone of an integrated service delivery model in Ireland. Intern J of Care Path 14:27–29CrossRef
9.
Culliton G (2010) Irish Medical Times. September 3rd
10.
Mofidi A, Sedhom M, O’Shea K et al (2003) Screening of low back pain, Low Back Clinic. The clinical experience. Irish Med J 96(9):270–273
11.
Curley AE, Cassells M, Cook G, Dowling F (2004) Physiotherapy-led low back pain triage. The Irish Experience. Physiotherapy Ireland 25(2):3–9
12.
Flanagan A, Cunningham C, Murphy S (2008) The efficacy of the Waterford BackCare Programme. Physiotherapy Ireland 29(1):45–49
13.
Waddell G (2004) The back pain revolution, 2nd edn. Churchill Livingstone, Edinburgh
14.
15.
Airaksinen O, Brox J, Cedraschi C et al (2006) European guidelines for the management of chronic nonspecific low back pain, Chap 4. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRef
16.
17.
Manek NJ, MacGregor AJ (2005) Epidemiology of back disorders: prevalence, risk factors and prognosis. Curr Opin Rheumatol 17(2):134–140PubMed
18.
Turk D, Dworkin R, Allen R (2003) Core outcome domains for chronic pain clinical trials : IMMPACT recommendations. Pain 106:337–345PubMedCrossRef
19.
Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20PubMed
20.
Stratford PW, Binkley JM, Riddle DL et al (1998) Sensitivity to change of the Roland Morris back pain questionnaire Part 1. Phys Ther 78:1186–1196PubMed
21.
Roland M, Morris R (1983) A study of the natural history of back pain. Part 1: development of a reliable and sensitive measure of disability in low back pain. Spine 8:141–144PubMedCrossRef
22.
Forshaw P, Hope M (1999) Assessment of psychological distress is important in the patients presenting with low back pain. Physiotherapy 85(10):563–570CrossRef
23.
Cairns M, Foster N, Wright C et al (2003) Level of distress in recurrent low back pain population referred for physical therapy. Spine 28(9):953–959PubMed
24.
Fairbank J, Frost H, Wilson-MacDonald J et al (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain, the MRC Spine stabilisation trial. BMJ 330(7502):1233PubMedCrossRef
25.
Main C, Wood P, Hollis S et al (1992) The distress and risk assessment method. A simple Patient classification to identify distress and evaluate the risk of poor outcome. Spine 17(1):42–51PubMedCrossRef
26.
Symonds T, Burton K, Tillotson K et al (1996) Do attitudes and Beliefs influence work loss due to Low Back Trouble? Occup Med 46(1):5–32CrossRef
27.
Simmonds MJ, Olson S, Jones S et al (1998) Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 23(22):2412–2421PubMedCrossRef
28.
Saur P, Ensink F, Frese K et al (1996) Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility. Spine 21(11):1332–1338PubMedCrossRef
29.
Predictive Analytics Software (PASW) (2009) Release 18.0.0, July 30. SPSS Inc, Chicago
30.
Hill J, Whitehurst D, Lewis M et al. (2011) Comparsion of stratified primary care management for low back pain with current best practice (STarT BacK): a randomised controlled trial. www.​thelancet.​com Published online 29 Sept 2011 DOI:10.​1016/​S0140-6736(11) 60937-9
31.
Altinel P, Kose K, Ergan V et al (2008) Prevalence of low back pain and risk factors among adult population in Afyon region, Turkey. Acta Orthop Traumatol Turc 42(5):328–332PubMedCrossRef
32.
33.
Deyo R, Mirza S, Martin B (2006) Back Pain prevalence and visit rates. Estimates from US National Survey 2002. Spine 31(23):2724–2727PubMedCrossRef
34.
Brevik H, Collect B, Ventafridda V et al (2006) Survey of chronic pain in Europe. Prevalence, impact on daily life and treatment. Eur J Pain 10:287–333CrossRef
35.
Bertakis K, Azari R, Helms J et al (2000) Gender differences in the utilisation of Health Care Services. J Fam Pract 49:2
36.
Indahl A, Velund RN, Reikeraas O (1995) Good prognosis for low back pain when left untampered. Spine 20(4):473–477PubMedCrossRef
37.
Croft PR, Dunn KM, Raspe H (2006) Course and prognosis of back pain in primary care: the epidemiological perspective. Pain 122:1–3PubMedCrossRef
38.
Rabey M, Morgans S, Barret C (2009) Orthopaedic physiotherapy practitioners: surgical and radiological referral rates. Clin Govern Int J 14(1):15–19CrossRef
39.
Chapman J, Norvell D, Hermsmeyer J et al (2011) Evaluating common outcomes for measuring treatment success for chronic Low Back Pain. Spine 36(21S):S54–S68PubMedCrossRef
40.
Lamb S, Hansen Z, Lass R et al (2010) Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet 375(9718):916–923PubMedCrossRef
41.
Johnson R, Jones G, Wiles N et al (2007) Active exercise, education and cognitive behavioural therapy for persistent disabling low back pain. Spine 32(15):1578–1585PubMedCrossRef
42.
Burton AK, Tillotson M, Main C et al (1995) Psychosocial predictors of outcome in acute and sub-chronic low back trouble. Spine 20:722–728PubMedCrossRef
43.
Foster N, Thomas E, Bishop A, Dunn K, Main C (2010) Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain 148(3):398–406PubMedCrossRef
44.
Bishop A, Foster NE (2005) Do physical therapist in the United Kingdom recognise psychosocial factors in patients with acute low back pain? Spine 30:1316–1322PubMedCrossRef
45.
Fullen BM, Maher T, Bury G et al (2007) Adherence of Irish General practitioners to European Guidelines for acute low back pain: a prospective pilot study. Eur J Pain 11:614–623PubMedCrossRef
46.
McCreesh K, Sorohan A (2011) Are Irish Physiotherapists managing low back pain in line with Clinical Guideline Recommendations?. World Physical Therapy 2011 Abstracts. Physiotherapy 97(1):eS1–eS1638
47.
48.
Hayden J, Chou R, Hogg-Johnson S et al (2009) Systematic reviews of low back pain prognosis had variable methods and results—guidance for future prognosis reviews. J Clin Epidemiol 62:781–796PubMedCrossRef
49.
Keeley P, Creed F, Tomenson B et al (2008) Psychosocial predictors of health related quality of life and health service utilisation in people with chronic low back pain. Pain 135:142–150PubMedCrossRef
50.
Mallen C, Peat G, Thomas E et al (2007) Prognostic factors for musculoskeletal pain in primary care: a systematic review. Br J Gen Pract 57:655–661PubMed
51.
Foster N, Hill J, Hay E (2011) Sub-grouping patients with low back pain in primary care: are we getting any better at it? Man Ther 16:3–8PubMedCrossRef
52.
Desmueles F, Roy J-S, Mac Dermid J et al (2012) Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet disord 13:107CrossRef
53.
Daker-White G, Carr A, Harvey I (1999) A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health 53:643–650PubMedCrossRef
54.
Richardson B, Shepstone L, Poland F et al (2005) Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital. Emerg Med J 22:87–92PubMedCrossRef
Metadata
Title
The role of clinical specialist Physiotherapists in the management of low back pain in a Spinal Triage Clinic
Authors
S. Murphy
C. Blake
C. K. Power
B. M. Fullen
Publication date
01-12-2013
Publisher
Springer London
Published in
Irish Journal of Medical Science (1971 -) / Issue 4/2013
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI
https://doi.org/10.1007/s11845-013-0945-7

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