The role of clinical specialist Physiotherapists in the management of low back pain in a Spinal Triage Clinic
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ORIGINAL ARTICLE
The role of clinical specialist Physiotherapists in the management of low back pain in a Spinal Triage Clinic S. Murphy • C. Blake • C. K. Power B. M. Fullen
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Received: 27 September 2012 / Accepted: 25 March 2013 Ó Royal Academy of Medicine in Ireland 2013
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. Keywords Low back pain Musculoskeletal triage Physiotherapy Pain Disability Psychosocial status
Introduction S. Murphy C. Blake B. M. Fullen School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland S. Murphy Spinal Triage Clinic, Waterford Regional Hospital, Waterford, Ireland S. Murphy (&) BackCare Programme, Waterford Regional Hospital, Waterford, Ireland e-mail: [email protected] C. K. Power Pain Service, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
Although low back pain (LBP) is regarded as benign, it constitutes a major public health problem in western industrialised countries, placing significant burden on health services [1]. Statistics on costs of LBP in Ireland are scant but in 2004 chronic LBP hospital costs amounted to €28 million and 33,713 bed days [2]. No specific LBP guidelines exist in Ireland to direct management and clinical pathways o
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