Treatment of low back pain in 2020: monitoring clinical practice through audit


The physiotherapy management of low back pain (LBP) has changed over the past few decades. The most recently published UK audit of physiotherapy practice in this area (Sparkes 2005) now looks very outdated: an update is required.  


A notes audit was undertaken to assess our practice against national guidance by identifying treatments offered to patients with LBP. Over a 1 week period, consecutive patients with LBP attending a large musculoskeletal physiotherapy out-patient service were recruited into the audit. 

Data were compared to National Institute for Health and Care Excellence (NICE) national guidance 59, NICE quality standard 155 and also to the historic data from the 2005 survey.  


During the audit week, 54 people with LBP attended for a new patient appointment. They all completed the STarT Back Questionnaire, which enabled clinicians to stratify patients into low, medium or high-risk of poor outcome from their LBP episode. 14 (26%) were low risk, 16 (29.6%) were medium risk and 24 (44.4%) were high risk. 
All patients were provided with a personalised home exercise programme. 36 (66.6%) were documented as being given specific LBP self-management advice. 16 (29.6%) were given a “managing low back pain” information booklet. 34 (63%) were given advice on the signs of potential cauda equina syndrome and what to do should these signs appear. 6 (11.1%) were referred into a back rehabilitation exercise and education class. 4 (7.4%) were referred for a course of hydrotherapy. 3 (5.6%) were given specific return-to-work advice. 2 (3.7%) patients were listed for a course of manual therapy. 1 (1.8%) patient had oversight review with the spinal consultant physiotherapist and was referred for an urgent MR scan.  

Cost and savings

This was a zero cost project 


Guidelines for the management of LBP have markedly changed since the 2005 audit of physiotherapy practice. The data presented here shows that practice has changed within this period; there are far fewer passive treatments and a much heavier reliance on self-management. 

Utilising the patient stratification STarT Back Questionnaire and spinal pathway we have demonstrated consistent patient management strategies for people presenting with LBP; these are in line with national guidance.  

Top three learning points

1. This project highlights the importance of utilising a Risk Stratification Tool to highlight both the physical and psychosocial needs of patients presenting with LBP.

2. This risk-stratified approach reduces over treating low risk patients and undertreating high-risk patients.

3. Guidelines for physiotherapy management of LBP have led to changes in practice.  

Funding acknowledgements