Claire MacKelvie BSc (hons) MCSPClinical Physiotherapy Specialist

WSPG 30/11/11

Outline

Background

The service

Some facts and figures

http://www.staffnet.ggc.scot.nhs.uk/Pages/ggbps.aspx

WSPG 30/11/11

WSPG 30/11/11

Rising Trend of LBP disability ( Waddell, The Back Pain Revolution, 2004 )

Guidelines:

•RCGP 1999 – underpins GGCBPS

•AHCPR 1994

•Kendall et al 1997

Reminder RCGP guidelines

For acute NSLBP – quality subjective, reassurance ++

Acute nerve root –reassure with caution. Consider surgical review 3 months

Potential SSP – refer on for medical review urgently

WSPG 30/11/11

Pilot of ServicePilot carried out April1999 – March 2000

1281 referrals, 88.5% seen within 2 weeks

95% RTW within 4/52

9.8% had psychosocial issues / distress

WSPG 30/11/11

WSPG 30/11/11

GGBPS Mission Statement

“The GGBPS aims to provide the highest standards of care to the healthcare users of Greater Glasgow. The service is evidence based, and systematically evaluated and developed to ensure this. Patient centred, we will respect the individuality of all patients and their carers. Using a bio psychosocial model of back pain, self-management and the principles of rehabilitation are central to the service approach; the aim is to develop the GGBPS as a centre of excellence for the management of patients with low back pain.”

GGBPS Pathway Document Version 2.1 Feb 2010

WSPG 30/11/11

11.5 clinical specialist physios, 2.8 Clinical Psychologists

Lead clinician

21 sites

Pathways to radiology / surgery

Standards of GGCBPS

possible acute Nerve Root seen within 1 week

Acute NSLBP ( buttock and LBP) seen within 2 weeks

(Acute - 6 weeks of pain or less)

WSPG 30/11/11

Specialist Role

Clinical ( 60%)

educational (20%)

service development (20%)

WSPG 30/11/11

Referral sources 2010

55%

24%

7%

14%

0%

self referral

GP

Consultant

Physio colleague

Other

WSPG 30/11/11

National LBP Audit 2009

Glasgow did well compared with national outcomes of documented subjective measures in LBP

WSPG 30/11/11

Back Pain Numbers Seen in Greater Glasgow Area from 2008-2010

0

1000

2000

3000

4000

5000

6000

7000

8000

2008 2009 2010

specialists

MSK staff

WSPG 30/11/11

Glasgow LBP Acute / non acute split 2010

WSPG 30/11/11

What exit routes GGCBPS offersSelf careMRI / surgical reviewPhysio led back class Psychology led back class (evolved to be

offered diff support) refer to workbookPain Education ClassesDEXA ( not exclusive to GGCBPS physios )

Community based exercise classes

WSPG 30/11/11

Exit Routes 2010

58%19%

2%1%5% 1%2%

8% 5%1% Self care

FTAPhysio led back classCommunity back classGPPsychology / EBCPain clinicSurgeryOtherInappropriate not LBP

WSPG 30/11/11

Enhanced Back Classpsychosocial risk factors LBP< 1 year, not making progress at 6/52joint psychology and physiotherapy a Cognitive Behavioural ApproachStatistically significant reduction in anxiety, fear avoidance & disability

WSPG 30/11/11

Pain Education Classes Professor McEwen report

Professor Moseley - understand pain

6 weeks, 3 hours, 2 sites.

Aims to: Optimise patient understanding & self mgt

skills Theory & practical – interactive /

individualised Home tasks to promote integration into

lifestyle WSPG 30/11/11

Physio led back classesGraded Activity can reduce Pain Related Fear

and improve function and ability ( Klaber Moffett, Spine 2004

and Cochrane Review 2010)

All MSK pain patients have increased risk of morbidity, CV and Ca (McBeth, J et al. Rheumatology 2009 and Torrance, N Eur J Pain 2010 )

Scottish Government targets / Quality Strategy

WSPG 30/11/11

What else does GGCBPS offer?

Training PackagesTriage to dischargeYellow flag training / dept

tutorialsBand 5 core LBP in-servicePain Ed Classes training

for referrersDaily resource for staff /

IST

WSPG 30/11/11

Clinical supportCase studiesCritical appraisal

papersIn-service locallySpecialist review for

2nd opinion / onwards ref

Advice on SSP / CES

Websitehttp://

www.staffnet.ggc.scot.nhs.uk/Pages/ggbps.aspx

Pathway DocumentLit reviewsReferral templates Patient advice resourcesCalendar of training

WSPG 30/11/11

DatabaseRecently revamped

Collated data across GGC

Opportunity for audit / research improved

WSPG 30/11/11

Outline

Background

The service

Some facts and figures

http://www.staffnet.ggc.scot.nhs.uk/Pages/ggbps.aspx

WSPG 30/11/11