Greater Glasgow & Clyde Back Pain Service - Claire MacKelvie

Claire MacKelvie BSc (hons) MCSP Clinical Physiotherapy Specialist WSPG 30/11/11

Outline
Background
The service
Some facts and figures
http:// www.staffnet.ggc.scot.nhs.uk/Pages/ggbps.aspx
WSPG 30/11/11

WSPG 30/11/11
Rising Trend of LBP disability ( Waddell, The Back Pain Revolution, 2004 )
Guidelines:
RCGP 1999 – underpins GGCBPS
AHCPR 1994
Kendall et al 1997

Reminder RCGP guidelines
For acute NSLBP – quality subjective, reassurance ++
Acute nerve root –reassure with caution. Consider surgical review 3 months
Potential SSP – refer on for medical review urgently
WSPG 30/11/11

Pilot of Service
Pilot carried out April1999 – March 2000
1281 referrals, 88.5% seen within 2 weeks
95% RTW within 4/52
9.8% had psychosocial issues / distress
WSPG 30/11/11

WSPG 30/11/11 GGBPS Mission Statement “ The GGBPS aims to provide the highest standards of care to the healthcare users of Greater Glasgow. The service is evidence based , and systematically evaluated and developed to ensure this. Patient centred, we will respect the individuality of all patients and their carers. Using a bio psychosocial model of back pain , self-management and the principles of rehabilitation are central to the service approach; the aim is to develop the GGBPS as a centre of excellence for the management of patients with low back pain.” GGBPS Pathway Document Version 2.1 Feb 2010

WSPG 30/11/11
11.5 clinical specialist physios, 2.8 Clinical Psychologists
Lead clinician
21 sites
Pathways to radiology / surgery

Standards of GGCBPS
possible acute Nerve Root seen within 1 week
Acute NSLBP ( buttock and LBP) seen within 2 weeks
(Acute - 6 weeks of pain or less)
WSPG 30/11/11

Specialist Role
Clinical ( 60%)
educational (20%)
service development (20%)
WSPG 30/11/11

Referral sources 2010 WSPG 30/11/11

National LBP Audit 2009 Glasgow did well compared with national outcomes of documented subjective measures in LBP WSPG 30/11/11

Back Pain Numbers Seen in Greater Glasgow Area from 2008-2010 WSPG 30/11/11

Glasgow LBP Acute / non acute split 2010 WSPG 30/11/11

What exit routes GGCBPS offers
Self care
MRI / surgical review
Physio led back class
Psychology led back class (evolved to be offered diff support) refer to workbook
Pain Education Classes
DEXA ( not exclusive to GGCBPS physios )
Community based exercise classes
WSPG 30/11/11

Exit Routes 2010 WSPG 30/11/11

Enhanced Back Class
psychosocial risk factors
LBP< 1 year, not making progress at 6/52
joint psychology and physiotherapy
a Cognitive Behavioural Approach
Statistically significant reduction in anxiety,
fear avoidance & disability
WSPG 30/11/11

Pain Education Classes
Professor McEwen report
Professor Moseley - understand pain
6 weeks, 3 hours, 2 sites.
Aims to:
Optimise patient understanding & self mgt skills
Theory & practical – interactive / individualised
Home tasks to promote integration into lifestyle
WSPG 30/11/11

Physio led back classes
Graded Activity can reduce Pain Related Fear and improve function and ability ( Klaber Moffett, Spine 2004 and Cochrane Review 2010)
All MSK pain patients have increased risk of morbidity, CV and Ca (McBeth, J et al. Rheumatology 2009 and Torrance, N Eur J Pain 2010 )

Scottish Government targets / Quality Strategy
WSPG 30/11/11

What else does GGCBPS offer?
Training Packages
Triage to discharge
Yellow flag training / dept tutorials
Band 5 core LBP in-service
Pain Ed Classes training for referrers
Daily resource for staff / IST
WSPG 30/11/11
Clinical support
Case studies
Critical appraisal papers
In-service locally
Specialist review for 2 nd opinion / onwards ref
Advice on SSP / CES

Website
Pathway Document
Lit reviews
Referral templates
Patient advice resources
Calendar of training
WSPG 30/11/11

Database
Recently revamped
Collated data across GGC
Opportunity for audit / research improved
WSPG 30/11/11

Outline
Background
The service
Some facts and figures
WSPG 30/11/11

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Greater Glasgow & Clyde Back Pain Service - Claire MacKelvie

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