Uptake of Prompt Access Physiotherapy for New Episodes of Back Pain Presenting in Primary Care

Abstract

Summary Background Recent authoritative recommendations on the management of low back pain (LBP) in primary care include access to physical therapy, in ‘urgent' cases within 72 hours. However, the level of demand for such a service and the resulting physiotherapy workload are unknown. Aim To determine the uptake of a prompt-access physiotherapy service in primary care for patients with new episodes of LBP, and the consequent physiotherapy workload. Method Back pain clinics, staffed by a physiotherapist, were provided in general practices of varying size with catchment populations amounting to 10% of a typical health district in England. The general practitioners (GPs) were invited to refer new episodes of LBP in adults for prompt assessment and treatment. Results During the course of one year, 522 patients attended the practice-based clinics, on average within four days of referral. This represents about one-third (35%) of the total number of adult patients thought to be consulting their GPs with a new episode of LBP. We describe the characteristics, morbidity and patterns of attendance of patients; 70% had experienced symptoms for less than four weeks and a similar percentage required only one clinic visit. From the resulting physiotherapy workload we estimate the resource implications for Primary Care Groups of providing similar access to physiotherapy for this condition. Outcomes in a random sub-sample of patients seen by a physiotherapist suggest that a prompt access service is well received by them and effective in restoring function. Conclusion When provided with prompt access to physiotherapy for new episodes of LBP, GPs and their patients made selective use of the service. However, the criteria for selection are unclear since in terms of a range of factors, referred patients are indistinguishable from the generality of those presenting with LBP in primary care.