Designing a Back Management Service: the Exeter experience and first year results

Abstract

Background: The recent British Clinical Standards Advisory Group report on back pain highlighted the importance of primary care in the active management of acute back pain and, at the same time, recommended the establishment of rehabilitation services for those with subacute and chronic back pain. Objective: To describe a new Back Management Service (BMS) in Exeter and to review the first year's results. Methods: Analysis of observational data collected from the clinic and therapy database. Assessments: Clinic outcome assessed by diagnostic and referral patterns as well as by general practitioner questionnaire. The Back Management Programme was assessed by Short Form 36 (SF36), Hospital Anxiety and Depression score (HAD) and Oswestry Disability Index (ODI). Results: In the first year 297 patients were seen in the clinic; clinic triage resulted in confirmation of primary care diagnosis in 235 (79%) of patients, with diagnosis revised in 62 (21%). One hundred and eighty-nine (63.6%) patients were referred for therapy. Of these, 54 were referred for one-to-one therapy and 135 were referred for multidisciplinary review with 29 patients subsequently recruited into the Back Management Programme for rehabilitation. Two out of three outcome measures were significantly improved at the end of the 36-hour, four-week course. Conclusions: A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.