Aims and objectives:
To update the management of those suffering from chronic low back pain referred into the physiotherapy service in line with a growing body of research evidence. This supports the use of programmes, which encourage exercise, movement and goal setting and which address clients underlying beliefs and fears about their pain, and offers them an alternative view and management strategy. Research evidence indicates that these clients have significantly reduced disability compared with those treated with routine physiotherapy. These findings were supported by the outcomes of our initial pilot of this programme last year.
The PCT has been radically reviewing its management of musculoskeletal patients over the last year. All stakeholders have highlighted patients with chronic low back pain as a challenging group. This programme is one of the strands of this strategic review, with plans next year to make this mainstream and expand the service to include a psychology-based programme.
Support for the change:
Following the initial and subsequent pilots, the physiotherapy manager who has been leading the change has been working to strategically influence the key players in the PCT to make this
programme mainstream. Poster presentations have been shown at PCT events throughout the year, including the AGM, to increase awareness of the programme. Ensuring that the programme became one of the strands of the review of musculoskeletal services greatly helped this.
Patient and public influence:
Patient's views on the content and delivery of the initial pilot programme were collected on a weekly basis and at the end of the programme.
Patients are helped to formulate their own personal goals and action plans, which are continually reviewed.
Some patients' comments related to lack of space, so subsequent programmes were run in larger community spaces, i.e. the Medway Centre and a School Hall.
Exercise programmes have also been reviewed and altered.
Feedback has recently been received on how beneficial the relaxation element of the programme was and we are looking at incorporating this on a weekly basis.
We intend to gain more comments and take further questionnaires at 6 months after the intervention.
Impact on the workforce:
Multidisciplinary working, multi skilling between OT and PT is ongoing.
Development of TI's to support the programme.
Looking to possibility of development of clinical specialist within pain management.
Measuring the results:
Ongoing audit of physical and psychological measures, review at 6/12. These measures have been validated and have been shown to be reliable and are based on current best practice.
Ongoing user feedback a/a.
Improved performance:
The results and feedback from the pilot study were very promising;
Roland and Morris questionnaire - cumulative score, down from 85 to 60
Modified Somatic Perception Questionnaire - c.s., down from 91 to 54
Modified Zung Depressive Index - c.s., down from 175 to 138
An equally impressive reduction in distress levels was recorded, as well as important improvements in fitness levels.
Reflecting diversity:
There were very few exclusion criteria and no age limits.
Multidisciplinary staff groups.
The next phase is to include psychology option to widen the accessibility.
Sharing the learning:
Shared widely within PCT, at pct "celebrating success" event, at AGM, at orthopaedic and physio stakeholder events
Shared across north Derbyshire health community.
Shared with Nottingham Back Pain team, "gold standard" within Trent.
Outstanding features:
Pilot started with no funding, just driven by the sheer enthusiasm of the staff involved and a belief that this was the right way to go for our patients.
