Management of people with acute low back pain
Low back pain is a significant burden in terms of pain, disability and loss of quality of life for those who experience it. This is a global problem with data in Australia revealing that a quarter of the population having it any one time. The fiscal burden is reported to be about $5 billion a year of direct costs and indirect costs to be much the same again.
We know that quality of care is variable with research in primary care suggesting that fewer than 50% of people presenting with low back pain have a physical examination, and only about 25% have a neurological assessment.
National Health and Medical Research Council guidelines recommend that imaging is unnecessary for acute low back pain unless there are signs suggestive of a serious condition. Yet 25% of patients are referred for imaging after their first consultation, resulting in unnecessary Medicare expenditure.
To address these issues, the Agency for Clinical Innovation has produced the following support resources.
Clinical Model of Care Management of people with acute low back pain – model of care
The clinical model of care highlights three important areas for improvement:
- more appropriate clinical examination and use of radiological imaging only as necessary
- better use of appropriate analgesia
- enhanced patient education.
The model of care is designed for people presenting to health practitioners in primary care settings but will also be the guide for care in settings such as emergency departments.
Consumer booklet Best practice care for people with acute low back pain
The consumer information document Best practice care for people with acute low back pain has been developed to support the community’s understanding of what the model of care aims to address and why.
These consumer booklets can be ordered by local health districts at no charge from Toll Stream Direct
Consumer handout Managing low back pain
The consumer handout has been developed to provide simplified, practical messaging and allow for an individualised back pain recovery plan.
Key publications related to the model
A paper testing implementation of the ACI Acute Low Back Pain model of care in four NSW Health emergency departments was published in BMJ Quality and Safety. The trial resulted in the number of opioid prescriptions to patients for acute low back pain reducing by up to 24%. There was no increased in pain levels or any reduction in patient satisfaction.
This work was funded through the 2018 ACI Research Grant Scheme and is supported by the ACI Emergency Care Institute and Musculoskeletal Network. The ACI Emergency Care Institute is supporting the research team to explore rolling the trial out to other emergency departments.
More about the trial and results is available on the Emergency Care Institute website.
For more information, please contact the ACI Muscoloskeletal Network Manager.