Further improvements needed to back care services

An audit of physiotherapy management of low back pain, believed to be the first of its kind in the world, has been published with the aim of introducing a more consistent approach to treatment across Scotland.

The National Physiotherapy Low Back Pain Audit, published by NHS Quality Improvement Scotland, involved 186 NHS sites across all 16 health boards and two private providers. It was carried out during 2007 over two data cycles to compare progress. The CSP was involved throughout the process. Fraser Ferguson, project manager of the audit, said the exercise was unique: ‘This is the first time anywhere in the world that there has been an audit of physiotherapy management of low back pain.’ Health authorities in England and Wales have shown interest in using the datasets. ‘It would be good if there was a comparable study,’ Mr Ferguson added. The impetus for the study came from a 2007 NHS QIS health technology assessment, which found that standards of care varied considerably in Scotland. The audit aimed to identify the extent to which practice complies with national guidelines and the number of patients seen by musculoskeletal outpatient physiotherapy services. One of the most surprising results to emerge was the extent to which low back pain referrals to physiotherapy were being under-recorded. ‘Data suggested a referral rate of around 12,000 a year, but the audit recorded 56,000 referrals to physiotherapy in 2007. This is a significant result,’ said Mr Ferguson, adding that individual health boards could now see where under-recording was taking place. Overall, the study showed a significant improvement in consistency in adhering to national guidelines between the first and second cycle, he said. However, there was room for improvement, particularly in relation to the recording of patient risk factors – one patient in four was not being fully assessed for being at risk of spinal fracture – and only one in four patients was supplied with patient education material, the study found. As a result of the audit a framework for continual improvement has been developed to enable back pain providers to monitor progress and the team has introduced web-based resources with training packages produced by experts in areas such as red flag assessments. The key findings will be re-audited in 2010.
Author
Louise Hunt

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