NPLBPA 1st cycle results Who, What, Why, When and Where to'

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NPLBPA - 1st cycle resultsWho, What, Why, When
and Where to.

• Fraser Ferguson
• September 19th 2008

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National recommendations management of LBP takes
account of existing evidence based guidelines

what we had
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what we had

• No standardised data on the number of
• LBP patients referred to physiotherapy

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what we had

• No national view of quality of management
• or compliance with national guidelines

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what we had

• Anecdotal evidence indicated a variation
• in these levels within NHSS.

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not alone!
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what we did

• Engaged all health boards (n14) in Scotland to
  take part covering gt 600 staff gt 300 sites
• Developed evidence based dataset web based
  audit tool
• Five week audit on all discharged LBP patients

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Project Objectives
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your average patients physiotherapy LBP journey
in Scotland according to the 1st audit cycle
Competition entries by lunch. There is a prize!
LBP!!
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• Took in 1st cycle and was one of 1213 who gave
  consent for his data to be used
• One of 42,000 LBP patients attending
  physiotherapy annually
• Managed by one of gt300 physios in gt600 sites

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• 35 chance symptoms were recurrent
• Likely onset would have been insidious/gradual
  (67)
• There was a 50 chance this was his first visit
  to physio.

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• He wonders why in some parts of Scotland he could
  self refer and in others his GP controls access
• Why additional hurdles to jump before he sees a
  physio.
• Why does he need to see a GP first anyhow, when
  its physios who are really good at managing LBP?

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• A full subjective objective assessment was
  carried out
• 65 likely that yellow flags would be assessed to
  identify factors that could help him stop
  developing chronic pain
• 50/50 chance there was a full neuro assessment
  carried out
• He wonders why some do and some dont ?

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• Encouraged to keep active and in self management
• Less likely to be encouraged to return to sports
  and hobbies. Less advice about pacing these
• Plenty of advice on an excellent prognosis
• But not as much information about LBP recurring

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• Encouraged to exercise and given active
  functional restorative Rx
• Vvvvvvvvv slight chance I would be shortwaved,
  tractioned then ultrasounded..fingers crossed!
• 74 likely discharged to self care
• Hes not 100 sure what that actually is though

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• He was one of 74 of patients who felt they were
  improving when discharged
• This was in a mean of 4.24 Rx.
• He d heard of friends who only had but 2.34 Rx
  and some who 8.13 Rx
• He wonders is one is better or longer lasting??

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• Recording of indicators of serious spinal
  pathology were much more variable
• ..As were symptoms associated with CES
• He remembers watching ER last week this
  condition was a surgical emergency
• Varied documentation about the risk of spinal
  fracture.

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documentation of red flags
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documentation of CES
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• Lack of validated and consistent written
  information supplied was very varied.
• If symptoms were chronic (30 chance) then the
  information was even more variable
• He wonders (again!) why did his friend in one
  health board get a nice shiny Back Book but he
  didn't?

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back book acute LBP
50/50 split
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acute c/w chronic
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LBP c/w leg pain
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how will we move forward?

• Locally developed and owned action plans to
  change and develop clinical practice
• Shared practice and experience across regions

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effects of moving forward

• 2nd audit cycle full results April 2009
• Raised awareness of key clinical standards in 600
  physiotherapists
• A national system for ongoing monitoring of the
  quality of care
• Local solutions to national issues
• National communication-local changes
• Consensus

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Scotland wide consensus ?
Objective tests/definitions
Written education material
Safety
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Today should not be about
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what next today.

• Feedback from you
• Workshop 2 - RF/CES/Education material
• Workshop 3 - Action Plans to take home

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regional feedback

• 3 to 5 minutes max
• Main recommendations from your area
• Identify areas of strength
• Identify areas for change

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workshop 160mins

• Question 1 Red flags and Cauda Equina Syndrome
  (20mins)
• Is this due to a lack of documentation or
  application in practice?
• Reasons for either?
• How can this be improved in the second cycle
• Question 2 Validated and consistent written
  patient information. (25mins)
• What is the consensus on what is the best
  information to give?
• What are the main problems where you work with
  supplying the best information?
• What other written information do you supply?
• What areas of written LBP patient information
  are lacking?
• What can be done nationally to fill any gaps
  discussed?
• Feedback 15mins

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workshop 240mins

• Identify one or two key recommendations for your
  health board
• Produce an action plan that will address each
  recommendation you have listed
• Identify possible barriers to change
• Suggest ways to overcome these barriers.
• Provide timescales for these action plans