Psychosocial Screening of Low Back Pain Patients In a NHS Musculoskeletal Physiotherapy Service.

Purpose

Low back pain (LBP) is a major public health concern. Psychological, social and lifestyle factors are strong predictors of future LBP and disability but are seldom identified in clinical practice.

The Short Form Örebro Musculoskeletal Questionnaire (SFÖQ) has been developed to assist clinicians in this endeavour, showing utility in people with LBP.

The SFÖQ was mandated by the physiotherapy department at University Hospitals of Leicester NHS Trust in 2014 - to be completed by all patients at their initial consultation.

Following implementation, it was unknown if the SFÖQ was utilised by physiotherapists and if psychosocial and lifestyle factors and patients treatment goals/expectations were identified and thus documented within the physiotherapy notes.
 


Aims:

i) Determine the utilisation of the SFÖQ by physiotherapists.
 

ii) Identify physiotherapists screening and documentation rates of psychosocial and lifestyle factors and patients treatment goals/expectations within the physiotherapy notes.
 

iii) Determine if physiotherapists level of experience influenced the utilisation of SFOQ and screening and documentation of psychosocial and lifestyle factors and patients treatment goals/expectations.

 

Patients back pain beliefs
were documented by 20%, patients' treatment goals/expectations were documented by 40% and lifestyle factors by 62% of physiotherapists respectively.
Psychological factors
(e.g. depression and anxiety) were documented by 26% and social factors (e.g. work status, absenteeism) by 41% of physiotherapists respectively.

Approach

Retrospective data was collected from the notes of people presenting with LBP referred to Physiotherapy at UHL.

Patient notes were identified using the Physiotherapy IT system ´Tiara´ with the code M54.5 for LBP.

Between September 1st 2015 and September 1st 2016, 100 patient notes with a diagnosis code M54.5 were identified across UHL's three physiotherapy departments.

Auditor bias was considered during the data analysis as some members held a special interest in this topic. As a result auditors who were not involved in the study design and did not share this interest independently analysed the notes and validated the audit process.

Patients were not involved at any stage in this audit.

Outcomes

Eight-one records were included in the analysis.

26% of completed SFÖQ's were utilised by physiotherapists.

Psychological factors (e.g. depression and anxiety) were documented by 26% and social factors (e.g. work status, absenteeism) by 41% of physiotherapists respectively.

Patients back pain beliefs were documented by 20%, patients' treatment goals/expectations were documented by 40% and lifestyle factors by 62% of physiotherapists respectively.

There were no significant differences between clinical experience, SFÖQ utilisation and documentation.
 

Physiotherapists utilisation of the SFÖQ was consistently low irrespective of their clinical experience. Physiotherapists screening and documentation of psychological and social factors was also low. However, physiotherapists were mildly better screening for and documenting patients' lifestyle factors and treatment goals/expectations. This was consistent across differing levels of experience.

Implications

This data highlights a need to optimise training and support for physiotherapists treating people with LBP in order to better utilise and document psychosocial screening methods including tools such as the SFÖQ.

Funding acknowledgements

Not applicable

Additional notes

This work was presented at Physiotherapy UK 2019.