The Australian Commission on Safety and Quality in Health Care has developed these indicators to support health service organisations to monitor implementation of the care described in the Low Back Pain Clinical Care Standard (ACSQHC 2022). The indicators included in this specification are a tool to support local clinical quality improvement and may be used to support other quality assurance and peer review activities. The goal of the standard is to: - Improve the early assessment, management, review and appropriate referral of patients with low back pain
- Reduce the use of investigations and treatments that may be ineffective or unnecessary in managing low back pain.
The standard relates to the care that should be received by patients aged 16 years and over who present with low back pain, with or without leg pain. It covers the early clinical assessment, management, and review and referral of people with low back pain symptoms who present with a new acute episode. The standard applies to all healthcare settings where care is provided to patients with low back pain with or without leg pain, especially primary healthcare services, and emergency departments. This clinical care standard does not cover: - Delivery of surgical interventions or their indications for use
- Ongoing management of low back pain persisting longer than 12 weeks, beyond the initial management of an acute exacerbation (although many of the principles of care described may still be relevant)
- Diagnosis or treatment of specific causes of low back pain.
A clinical care standard contains a small number of quality statements that describe the clinical care expected for a specific clinical condition or procedure. Indicators are included for some quality statements to help health service organisations monitor how well they are implementing the care recommended in the clinical care standard. The quality statements that are included in the Low Back Pain Clinical Care Standard are as follows: - Initial clinical assessment. The assessment of a patient with a new presentation of low back pain symptoms, with or without leg pain or other neurological symptoms, focuses on screening for specific and/or serious pathology and consideration of psychosocial factors. It includes a targeted history and physical examination, with a focused neurological examination when appropriate. Arrangements are made for follow-up based on an evidence-based low back pain pathway.
- Psychosocial assessment. Early in each new presentation, a patient with low back pain, with or without leg pain or other neurological symptoms, is screened and assessed for psychosocial factors that may affect their recovery. This includes assessing their understanding of, and concerns about, diagnosis and pain, and the impact of pain on their life. The assessment is repeated at subsequent visits to measure progress.
- Reserve imaging for suspected serious pathology. Expectations of imaging and its limited role in diagnosing low back pain are discussed with a patient. Early and appropriate referral for imaging occurs when there are signs or symptoms of specific and/or serious pathology. The likelihood and significance of incidental findings are reported and discussed with the patient.
- Patient education and advice. A patient with low back pain is provided with information about their condition and receives targeted advice to increase their understanding, and address their concerns and expectations. The potential benefits, risks and costs of medicines and other treatment options are discussed, and the patient is supported to ask questions and share in decisions about their care.
- Encourage self-management and physical activity. A patient with low back pain is encouraged to stay active and continue, or return to, usual activity, including work, as soon as possible or feasible. Self-management strategies are discussed. The patient and clinician develop a plan together that includes practical advice to maximise function, and limit the impact of pain and other symptoms on daily life. The plan addresses individual needs and preferences.
- Physical and/or psychological interventions. A patient with low back pain is offered physical and/or psychological interventions based on their clinical and psychosocial assessment findings. Therapy is targeted at overcoming identified barriers to recovery.
- Judicious use of pain medicines. A patient is advised that the goal of pain medicines is to enable physical activity, not to eliminate pain. If a medicine is prescribed, it is in accordance with the current Therapeutic Guidelines, with ongoing review of benefit and clear stopping goals. Anticonvulsants, benzodiazepines and antidepressants are avoided, because their risks often outweigh potential benefits, and there is evidence of limited effectiveness. Opioid analgesics are considered only in carefully selected patients, at the lowest dose for the shortest duration possible.
- Review and referral. A patient with persisting or worsening symptoms, signs or function is reassessed at an early stage to determine the barriers to improvement. Referral for a multidisciplinary approach is considered. Specialist medical or surgical review is indicated for severe or progressive back or leg pain that is unresponsive to other therapy, progressive neurological deficits, or other signs of specific and/or serious pathology.
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