Developing Better Care for People with Acute Low Back Pain

Lead Contributors

• Chris Maher Chris Needs

• Manuela Ferreira Niamh Moloney

• Robyn Speerin

• Lyn March and Matt Jennings, MSK co-chairs

Process for building the Model of Care

Recognise gaps in muscusloskeletal practice Assemble of an interested group Facilitate the documentation of evidenced based

care Review Implement and evaluation Disseminate new information

Steel, N., 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), pp.1545-1602.

Previous Problems with ALBP management (1) 40% of people with an episode of ALBP will have

recovered within 6 weeks

However … almost 14% remain unrecovered at 12 months*

Acute Pain chronic pain

*Costa LM et al, The prognosis of acute and persistent low-back pain: a meta-analysis CMAJ, 2012; 184 :613-24

Previous Problems with ALBP management (2) Clinical assessment Best practice was not always occurring

Overuse of radiological imaging Not according to guidelines

Previous Problems with ALBP management (3)

Rintoul AC, Dobbin MD, Drummer OH, Ozanne-Smith J. Increasing deaths involving Oxycodone, Victoria, Australia, 2000-09. Inj Prev. 2011; 4:254-259.

North American Opiate Warning

“Overall, 1 of every 550 patients started on opioid

therapy died of opioid-related causes a median of 2.6 years after the first opioid prescription”

Frieden, T.R. and Houry, D., 2016. Reducing the risks of relief—the CDC opioid-prescribing guideline. New England Journal of Medicine, 374(16), pp.1501-1504.

Previous Problems with ALBP management (4) In summary:

High rate of transition from acute to chronic pain

History and examination is not comprehensive

Guidelines for imaging not adhered to

Use of some analgesia is unsafe

Patient education is lacking

Writing Group

Lyn March, Matthew Jennings, Jonathon Ball, Chris Barnett, Rosemary Baecher ,June Cather, Lyn Farthing,

Ian Harris, Mark Halliday, John Hayden, Jenni Johnson, Rodger Laurent, Catherine Maloney, Sandra McFaul, Michael Nicholas, Yari Nikolic, Jane O’Brien, Yanni Sergides, Debra Shirley, Ralph Stanford, Ian Starkey, John Vaughan, Tai-Tak Wan, Jenny Ly.

Reviewers Andrew Briggs ,Dragana Ceprnja, Mark Hancock Robin Haskins, Colin McArthur Ruth White, Simon Willcock

• Currently in final stages of development

• Informed by

the model of care and a consumer focus group advising on layout, wording and ‘what’s important’

Key Principles of The MoC for the Management of People with Acute Low Back Pain

Principles of Care

Principles of Care

Principles of Care

Principles of Care

Principles of Care

Basic Standards of Care

Implementation

Initially through: Musculoskeletal Primary Health Care Initiative Northern NSW Primary Health Network & Mid

North Coast Local Health District GP Collaborative with The Improvement

Foundation HealthPathways

Implementation strategies … Emergency Departments (ED) RPAH 2500 presentations/year

ED Physiotherapy group Development of acute back pain pathways within the ED’s RNSH Liverpool RPAH

Dedicated acute Back Pain Clinics managed by Rheumatologists and Physiotherapists

Ambulance Service survey of ALBP “call outs 2% relate to LBP

Founding Partners • Northern Sydney Local Health District (NSLHD) • Sydney Local Health District (SLHD) • Western Sydney Local Health District (WSLHD) • Sydney Children’s Hospital Network (SCHN) • The University of Sydney (USyd)

Sydney Health Partners An Advanced Health Research and Translation Centre

2016 MSK stream accepted ACI Model of Care received “Enabler” funding

In conclusion: overview MSK Network’s development of the ALBP MoC MSK Network identifies unmet need in management of ALBP

Inter professional collaboration (both academic and clinical)

Patient partners

Develop strategies to breach gaps in care

The Strengths of the ACI approach Brokering relationships

Builds ownership of outcomes from the participants

Able to fund implementation and evaluation

Acknowledgements

• Robyn Speerin • Chris Maher • Manuela Ferreira, Niamh Moloney,

• Many physiotherapists, • nurses, consumers • neurosurgeons, orthopaedic, pain specialists,

rheumatologists, GP’s • ---Musculoskeletal network members • Support from other ACI networks especially the Pain

Management Network

Questions?