extended back assesment quality development project in physiotherapy primary care clinics. 2003 –...

Extended Back AssesmentExtended Back Assesment

Quality development project in Quality development project in physiotherapy primary care clinics. physiotherapy primary care clinics.

2003 – 2012 2003 – 2012 Danish RegionsDanish Regions

© © Nils-Bo de Vos Andersen 2012Nils-Bo de Vos Andersen 2012

Extended Back Assesment (EBA)Extended Back Assesment (EBA)

Definition :Definition :

Extended back assesment in the primary care Extended back assesment in the primary care sector, performed by specially trained sector, performed by specially trained physiotherapists , is an evidence-based assessment physiotherapists , is an evidence-based assessment of the lumbar spine and pelvis, that offers the of the lumbar spine and pelvis, that offers the general practitioner a supplementary assessment general practitioner a supplementary assessment within a limited time rangewithin a limited time range

© Nils-Bo de Vos Andersen 2012

Extended Back Assesment (EBA): Extended Back Assesment (EBA):

• Low back pain is the leading cause of activity Low back pain is the leading cause of activity limitation and work absence throughout much of the limitation and work absence throughout much of the world world

• Expert opinion has likened the frequency of low back Expert opinion has likened the frequency of low back pain to an “epedemic”pain to an “epedemic”

• - and it associates with an enormous economic - and it associates with an enormous economic burdenburden

• Hoy 2010Hoy 2010



• A recent systematic review estimated the 1-year A recent systematic review estimated the 1-year prevalence of a first-ever episode of low back pain prevalence of a first-ever episode of low back pain to range between 6,3% and 15,3%to range between 6,3% and 15,3%

• Individuals who have experienced activity-Individuals who have experienced activity-limitying low back pain experience reoccurring limitying low back pain experience reoccurring episodes with estimates ranging between 24% episodes with estimates ranging between 24% and 33%and 33%

• Chronic low back pain has demonstrated rapid Chronic low back pain has demonstrated rapid increases from 3.9 % in 1992 to 10,2 % in 2006increases from 3.9 % in 1992 to 10,2 % in 2006

Stanton 2008 , Freburger 2009Stanton 2008 , Freburger 2009



• Psychosocial factors appear to play a larger Psychosocial factors appear to play a larger prognostic role than physical factors in low back prognostic role than physical factors in low back painpain

• Changes in behavioral variables and Changes in behavioral variables and improvement in function seem to be more improvement in function seem to be more important than physical performance factors for important than physical performance factors for succesful treatmentsuccesful treatment

• Wessels 2006Wessels 2006


Utilisation of validated patient self-report Utilisation of validated patient self-report questionairesquestionaires

Identification of risk factors that indicate the Identification of risk factors that indicate the development of chronicitydevelopment of chronicity

Evidence-based standardised clinical Evidence-based standardised clinical assessment assessment

EBA starting point = EBA starting point = Danish Medical Technological Evaluation Reports Danish Medical Technological Evaluation Reports

(MTV) recommondations 1999/ 2003(MTV) recommondations 1999/ 2003


Patient-information and instruction in self Patient-information and instruction in self mangement mangement

IT-based reports and communication IT-based reports and communication Improved co-work among primary care sector Improved co-work among primary care sector

personelpersonel

EBA starting point = MTV recommondationsEBA starting point = MTV recommondations


Aims of the EBA project: Aims of the EBA project:

Offer the general practitioner a supplementary assessment Offer the general practitioner a supplementary assessment of patients with low back pain within a limited time rangeof patients with low back pain within a limited time range

Enhance care taking of LBP patients in primary health care Enhance care taking of LBP patients in primary health care sector in order to reduce the number of people going on to sector in order to reduce the number of people going on to secondary care. secondary care.

Possibly reduced cost as early patient-specific treatment, Possibly reduced cost as early patient-specific treatment, go back to work earlier and no need for 2ndary HC.go back to work earlier and no need for 2ndary HC.


Inclusion criteria for EBA projectInclusion criteria for EBA project

Subacute or chronic low back pain patientsSubacute or chronic low back pain patients

With or without sciaticaWith or without sciatica

Activity-limitying low back painActivity-limitying low back pain

In the phase of evaluationIn the phase of evaluation


Participating physiotherapistsParticipating physiotherapists

Assessment to be initiated within 1 week of Assessment to be initiated within 1 week of receiving GP referralreceiving GP referral

An IT – based report of examination findings An IT – based report of examination findings classification and recommendations of the classification and recommendations of the patient has to be sent to the referring GP patient has to be sent to the referring GP within 2 weeks from the initial assessmentwithin 2 weeks from the initial assessment


Participating physiotherapists (cont’d)Participating physiotherapists (cont’d)

Must have a minimum of 5 years clinical Must have a minimum of 5 years clinical experience of working with LBP patients.experience of working with LBP patients.

Underwent supplementary postgraduate Underwent supplementary postgraduate education in assessment and classification of education in assessment and classification of patients with low back and referred pain.patients with low back and referred pain.

Have signed a contract stating they will use the Have signed a contract stating they will use the EBA assessment formsEBA assessment forms and and consent to have consent to have their work reviewed. their work reviewed.


Participating physiotherapistsParticipating physiotherapists

Four practice consultants overview the project Four practice consultants overview the project and ensure that minimum quality standards and ensure that minimum quality standards are met by the participating physiotherapists.are met by the participating physiotherapists.

In 2008 a quality database retrieving data In 2008 a quality database retrieving data from the project was developed. From sept. from the project was developed. From sept. 2009 the physiotherapists could register their 2009 the physiotherapists could register their patients electronically and enter all clinical patients electronically and enter all clinical data on the database FysDB data on the database FysDB


Internet-based IT - database – FYSDB Internet-based IT - database – FYSDB Patient-questionaires, assessment , classification Patient-questionaires, assessment , classification


Internet-based IT - database FYSDB Internet-based IT - database FYSDB – text is automatically generated to the patient report– text is automatically generated to the patient report


The database FysDB contains a mailbased retest-The database FysDB contains a mailbased retest-function, using patient self-report questionaires after function, using patient self-report questionaires after

3 - 6 and 12 month. 3 - 6 and 12 month.


The database FysDB contains statistics .The physiotherapists The database FysDB contains statistics .The physiotherapists have the possibility to compare their own results with the general have the possibility to compare their own results with the general

results of the Regionresults of the Region


30.07.2012 : 3038 patients are registered in the 30.07.2012 : 3038 patients are registered in the databasedatabase

Inclusion criteria for the EBA project meet Inclusion criteria for the EBA project meet demandsdemands

70% of all assessments are performed in areas 70% of all assessments are performed in areas with less specialized doctorswith less specialized doctors

217 participating physiotherapists in the 4 217 participating physiotherapists in the 4 Regions are oblige to use the database FysDBRegions are oblige to use the database FysDB

Status EBA projectStatus EBA project


The EBA has been evaluated by physiotherapy The EBA has been evaluated by physiotherapy practice consultants . The evaluation contains practice consultants . The evaluation contains quantitative and qualitative elements. quantitative and qualitative elements.

Evaluation was based on subjective Evaluation was based on subjective questionnaires to patients, doctors and questionnaires to patients, doctors and physiotherapistsphysiotherapists

Evaluationresults: high degree of satisfaction Evaluationresults: high degree of satisfaction among all groupsamong all groups

EBA project 2004 to 2006EBA project 2004 to 2006


The contend and set up of the EBA has been The contend and set up of the EBA has been evaluated by researcher Tom Pedersen Copen- hagen evaluated by researcher Tom Pedersen Copen- hagen Backcenter in a report 2009, stating that the Backcenter in a report 2009, stating that the assessment meet best practice standards.assessment meet best practice standards.

An evaluation report has been set up by the Public An evaluation report has been set up by the Public health and Qualitydevelopment Center- health and Qualitydevelopment Center- Marselisborgcenter Region Midtjylland 2011 stating Marselisborgcenter Region Midtjylland 2011 stating improvements on activity-limitations, but not on improvements on activity-limitations, but not on reduced sickleave.reduced sickleave.

EBA project 2007 to 2012EBA project 2007 to 2012


Perspectives for the future Perspectives for the future

EBA quality development is presently EBA quality development is presently implemented in 4 out of 5 Regions: Region implemented in 4 out of 5 Regions: Region Midtjylland, Region Nordjylland, Region Midtjylland, Region Nordjylland, Region Syddanmark and as a project in Region Syddanmark and as a project in Region Hovedstaden.Hovedstaden.

2011 in the Region Midtjylland and 2011 in the Region Midtjylland and Syddanmark the EBA has been accepted as a Syddanmark the EBA has been accepted as a part of the Regional programme for low back part of the Regional programme for low back patients during their course in the primary patients during their course in the primary care sector.care sector.



Proposal for the EBA:Proposal for the EBA:

The setup of a prospective longitudinal The setup of a prospective longitudinal randomized study including a control group. It randomized study including a control group. It is necessary for evaluation of effect, that the is necessary for evaluation of effect, that the target group is randomly divided into 2 target group is randomly divided into 2 groups.groups.



Different aspects can be evaluated:Different aspects can be evaluated:

Data or questionnaires at 3/12 and 6/12, 12/12 - Data or questionnaires at 3/12 and 6/12, 12/12 - or longer. or longer.

Stay at work during episode; return to work + Stay at work during episode; return to work + period of sick leave; evaluate by HC Registerperiod of sick leave; evaluate by HC Register

Pattern of Health Care utilization Social Welfare Pattern of Health Care utilization Social Welfare benefits; evaluate by HC Registerbenefits; evaluate by HC Register

Self-estimated health status and functional Self-estimated health status and functional ability, especially work capacity, patient ability, especially work capacity, patient satisfactionsatisfaction


Thank you for your attention. Thank you for your attention.

Contact and networking please write: Contact and networking please write:

[email protected]@stab.rm.dk


extended back assesment quality development project in physiotherapy primary care clinics. 2003 –...

Documents

pain changes

world low

frequency of low

episode of low

pain psychosocial factors

vos andersen

physical factors

assesment eba definition