1. The North of England Regional Back Pain Pathway
Nicki Skinner MSc MCSP MMACP
Triage and Treat Practitioner
17th March 2016

2. Background Acute LBP experienced by 90% of population
Back pain is largest cause of disability in UK (11% of disability burden) Global burden of disease 2010
Cost to NHS >£2 billion annually (Nice 2008)
Huge management variation nationally and locally
Poor adherence to evidence based guidelines

4. GP/Self Referral to Physio
1st consultation
GP/Self Referral to Physio
2nd consultation
GP – STarT Back
Triage and Treat
Core Therapies
Imaging
Discharge
Pain Clinic
NRB
Surgical Opinion
CPPP
Red Flags
Local Pathway

5. What’s new?
Evidence based care with emphasis on prevention of chronicity
Standardised managed pathway with consistent message from all healthcare professionals
Integrated pathway with rapid access to appropriate services
Combined physical and psychological programme (CPPP) – Back to Health
Save money!

6. STarT Back APPROACH
STarT Back tool – 9 item self-reported questionnaire
Physical and psychological constructs
STarT Back stratifies patients according to their risk of persistent disability due to back pain.
Scored as high, medium or low risk
Hill et al (2011) – stratified care is cost effective with targeted care towards med/high risk and avoids over-treatment of low risk

7. Managed pathway Triage and Treat
Spinal specialists – physiotherapists, nurses
Named clinician responsible for each patient
Working in an extended scope role with responsibility for ordering and interpreting investigations then directing care appropriately
Promote and reinforce self-management
Part of the MDT team

8. Consistent message
Every clinician has the potential to be a yellow flag. (Darlow et al 2013)
Patient and clinician beliefs affect outcomes
“Weakness, instability, trapped nerves, wear and tear, disc bulge, degeneration”
versus
“Safe, strong, sensitive, active, relaxation, normal”
Reassurance, advice and information to promote self-management.

9. Back to Health (CPPP)
NICE (2009) – programme consisting of around 100 hrs over maximum 8 weeks
Spinal Taskforce (2013) – serious gap in current services and recommendation to commissioners
MDT approach
Change mindsets
Improve self management
Increase exercise and functional ability
Demedicalise
Return to work

10. Physiotherapy and the future!
Sir Bruce Keogh supporting national roll out
Physiotherapists best placed to lead and deliver services.
Advanced clinical reasoning
Exercise prescription
Manual therapists
Acupuncture
Relaxation
Cognitive behavioural therapy
Team workers