Family Practice Vol. 21, No. 4, 372-380
Family Practice Vol. 21, No. 4 © Oxford University Press 2004, all rights reserved.
An evaluation of prompt access to physiotherapy in the management of low back pain in primary care
a Cheshire West Primary Care Trust, b Department of Primary Care and c Department of Allied Health Professions (Physiotherapy), University of Liverpool and d Halton Primary Care Trust
Correspondence to Julia Miller, R&D Manager, Halton Primary Care Trust, Victoria House, Holloway, Runcorn, Cheshire WA7 4TH, UK; E-mail: julia.miller{at}halton-pct.nhs.uk
Background. Disability arising from low back pain (LBP) is a growing problem. Current primary care management of LBP has been criticized for its mechanistic basis and for delays in gaining access to specialist advice. Among recent recommendations made for improved management are functional explanatory models, a rehabilitative approach and early access to physical therapy. It is not known if these recommendations can be implemented in mainstream primary care.
Objective. The purpose of our study was to examine the feasibility, acceptability and component costs of providing a prompt access physiotherapy service for new episodes of LBP in primary care; to describe outcomes and compare them with other published interventions; and to explore the influence of the service on GPs' approach to LBP.
Methods. Back pain clinics staffed by a physiotherapist were established in a group of demographically representative practices in a typical UK health authority. Adult patients with a new episode of LBP referred by their GPs were managed in accordance with recent recommendations. Data on pain, disability and well-being were collected at recruitment and some 12 weeks later. Patient diaries and interviews with GPs before and after the study provided qualitative data. Comparative costings were derived from national and local sources.
Results. A total of 614 patients, representing 3.2% of the adult population, were referred, of whom 522 (85%) were seen at the back pain clinics within 3–4 days, the majority within 72 h. Although this represents less than half the adult patients thought to be presenting to their GPs with LBP, patients exhibited levels of pain and disability comparable with those described in other studies of LBP in primary care. More than 70% of patients required only a single clinic visit and <5% were referred on to specialist orthopaedic or back pain rehabilitation services. At follow-up, levels of improvement were comparable with and time taken off work superior to those seen in other intervention studies of LBP in primary care. Prompt access to physiotherapy in primary care costs less per episode of LBP than conventional management. Qualitative data suggest that patients valued early access to the physiotherapist, particularly for the reassurance provided. Interviews with GPs revealed strong support for the service, in large part based on favourable feedback from patients.
Conclusions. For primary care patients with a new episode of LBP referred by their GP, prompt access to a dedicated physiotherapy service is both feasible and acceptable. Comparison with other published interventions suggests that it is also cost-effective and that a typical Primary Care Trust (PCT) would rapidly recoup the cost of additional physiotherapists. However, questions remain about the availability of sufficient physiotherapists to make such a service available nationally. The influence of the service upon GPs' own approach to the management of LBP is likely to be gradual and to come about largely through positive feedback from patients.
Keywords. Low back pain, primary care, prompt access physiotherapy.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. M Hughes and C. M Bleakley Treatment of knee pain in primary care: Pharmacists and physiotherapists need to be a part of the team BMJ, November 11, 2006; 333(7576): 981 - 982. [Full Text] [PDF]
|
|