Evaluation of the implementation of the Clinical Standards Advisory Group (CSAG) recommendations regarding the management of low back pain (LBP).
The team at the Chester Halton Community NHS Trust asked GPs at five general practices to refer all patients between 18 and 65 who presented to them with a new episode of LBP. Patients were assessed by a research physiotherapist in practice-based back pain clinics, and a research assistant gathered data first at initial assessment and again after 1 2 weeks. Assessment, treatment and advice were based on a multidimensional biopsychosocial model and conformed to CSAG recommendations.
The preliminary results are very encouraging. 85% of those referred attended for assessment and treatment, and of those 64% were seen within 72 hours. 72% were seen only once by the research physiotherapist and discharged, less than 3% needed referral to orthopaedics and 2.5% to back pain rehabilitation. The majority of subjects gave positive feedback regarding the management of their low back pain, although at follow up, 14% continued to take prescribed medication and a further 14% were taking self-medication.
The conclusion of the team was that implementation of the CSAG guidelines is feasible within a physiotherapist-led LBP service in primary care.
Emma Tait, BackCare's Executive Director, commented: "Earlier this year, a survey published in the BMJ reported that there have been only small, if any, increases in the referral of patients to physical therapists despite the CSAG and Royal College of General Practitioners (RCGP) guidelines recommending early referral. Studies like this one are essential if back pain patients are to benefit from the guidelines."
Barnett A G, Underwood M R, Vickers M R Effect of UK national guidelines on services to treat patients with acute low back pain: follow up questionnaire survey BMJ 1999-1318:919-20
Further reading: Evaluating the implementation of national guidelines in the management of low back pain in primary care. JS Miller, MA Pinnington, GB Rose, MJ Rose, IM Stanley