Service evaluation of patient outcomes at Defence Medical Rehabilitation Centre Stanford Hall following multidisciplinary rehabilitation for persistent low back pain.

Purpose

Low back pain is a particularly common musculoskeletal disorder which causes varying degrees of disability. At Defence Medical Rehabilitation Centre Stanford Hall, management of Service personnel with persistent low back pain follows a biopsychosocial model of best practice guidelines developed in-house and in line with the National Institute for Health and Care Excellence guidelines. Patients are admitted for a 3-week rehabilitation course and managed by a multidisciplinary team (MDT) consisting of a consultant, doctor, physiotherapists, exercise rehabilitation instructors, occupational therapist, social worker, mental health team, recreational therapist, pain nurse, pain consultant, pain psychologist and dietician. The aim of this service evaluation is to analyse patient outcomes following their inpatient admission.

21.7%
average improvement in anxiety score (GAD-7)
21.5%
average improvement in depression score (PHQ-9)

Approach

Through a retrospective observational study; analysis of patient reported outcome measures such as Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Oswestry Disability Index (ODI), Tampa Scale of Kinesiophobia (TSK) and Brief Pain Inventory (BPI) was performed comparing admission and discharge data of 44 patients following inpatient rehabilitation from October 2019 to February 2020. Following an admission process by the MDT, a structured 3-week inpatient rehabilitation commences and includes both group-based and individualised components of physical and educational aspects. Group-based activities include education on pain, sleep, planning and pacing, seating and posture, and program design; relaxation therapy; aquatic therapy; mobility and cardiovascular sessions, and functional movements. Individual physiotherapy sessions are conducted once or twice weekly depending on patient need, with focus on patient education and address patients’ musculoskeletal deficits. Individualised prescription of exercise is performed through a clinical reasoning process based on functional limitations and patient goals.

Outcomes

Results: Following the inpatient rehabilitation courses from October 2019 to March 2020, there were improvements in the majority of the patient reported outcomes apart from ODI which decreased by an average of 6.6%. The biggest average improvements in patient outcomes were seen in both anxiety (GAD-7) by 21.7% and depression (PHQ-9) by 21.5%. BPI-lifestyle and TSK scores improved by an average 13.7% and 5.1% respectively. Minimal improvement was in pain scores by an average of 0.8%.

Conclusion(s): A 3-week inpatient rehabilitation of service personnel for persistent low back pain following a biopsychosocial approach has an effect of causing improvements on the majority of their health-related outcomes despite marginal improvements in pain levels. These improvements occur in a set up involving a MDT.

Cost and savings

No monetary costs were involved

Implications

This work shows that physiotherapy in conjunction with the wider MDT is needed in the management of persistent low back pain. It should focus on a biopsychosocial model including both physical and educational components which encourage better self-management. Future research is needed to analyse any potential benefits which can be gained after patients have had a period of a few months to follow advice and exercises provided within the course.

Top three learning points

No further information. 

Funding acknowledgements

Unfunded.