Introduction: the NHS places emphasis on outcomes and patient partnerships but measuring these factors is problematic. In 2003 the Spinal Assessment Clinic (SAC) moved from an old style hospital to a new PFI building providing an opportunity to audit the influence of environment on operational activity.

Objective: Does environment influence satisfaction with care and objective outcome in patients with LBP?

Method: Patients attending the SAC two months prior to relocation and two months following completed a Low Back Outcome Score (LBOS) and a satisfaction survey.

Results: The analysis of the satisfaction surveys demonstrated that the patients did not perceive any real difference in the two locations despite the significant age difference, layout and internal standards of the buildings.

The satisfaction of patients at both sites was analysed using a number of factors- the care provided was 79% before the move and 82% afterwards, their understanding of a nurse led service was rated as 73% and 85% respectively. Evaluation of the quality of information demonstrated that their questions had been answered well 78% and 75% respectively and the confidence and trust in the person providing the care was 91% and 89%.

Failure by the IT department in delivering effective links to hospital computer system resulted in the LBOS data not being completed in the period following the move with logistical difficulties in clinic organisation.

Conclusion: despite the difficulty of moving and problems encountered by staff from the SAC the patient did not perceive any alteration in quality.

Introduction: After a year in post, the waiting time to see the spinal surgeon in a large hospital had risen from 0–62 weeks. A nurse-led assessment clinic was inaugurated to triage patients, cut waiting times and accelerate treatment.

Methods: Referrals were taken directly from general practitioners, and patients triaged using proforma history and examination systems into five categories: mechanical back pain, nerve root entrapment, potentially serious pathology, unknown diagnosis and suitable manipulative therapy.

Audit based on direct patient entry with a light pen interface was integrated into the process. Seventy percent of patients were referred complaining of mechanical back pain, and an Educational Rehabilitation Programme was provided within the clinic.

Results: Following the inauguration of the spinal assessment clinic, waiting times in the consultant clinic fell from 62 weeks to 26 weeks; waiting times in the assessment clinic were between four and six weeks. Emergencies may be seen the same week.

The time from GP referral to surgery for routine nerve root compression fell from 92 weeks to 24 weeks (of which 12 weeks was waiting time for scanning).

Detailed audit of scanning requests in 127 patients demonstrated confirmation of clinical diagnosis in 80 percent of whom half went on to surgery. Of the 20 percent with negative scans, a fifth were subsequently found to have trochanteric bursitis.

An audit of 94 patients revealed reduced analgesic consumption, increased return to work and reduced consultation rates at one year. Five patients were referred to other clinics for further consultation. The satisfaction of the clinic amongst general practitioners was 94 percent. Referrals to the clinic have risen from 403 in 1993 to 1511 in 1999, necessitating the appointment of three further nurse practitioners. Prospective review of 104 patients revealed 95 percent satisfaction rate of the clinic and 67 percent satisfaction rate with rehabilitation. Average low back outcome score increased from 29 to 35 (p< 0.001).

A training programme for nurse practitioners has been established and, to date, ten of the clinics have been inaugurated nation-wide using this model.

Conclusions: A nurse-led clinic for triage of back pain patients has had major impact on waiting times, has produced measurable improvements in patients’ outcome and is associated with high satisfaction ratings in both patients and general practitioners.

Patients with mechanical back pain have been treated in a nurse-led spinal clinic. They attend two one-on-one sessions with a nurse, the second session usually between three and 12 months after the first. Between these visits, they also attended two sets of classes in the spinal assessment clinic to help them improve and manage their back pain. A questionnaire is completed at presentation and at review.

The questionnaires include three scores: The low back outcome Score, MSPQ and the Zung Depression Scale. Since 1995, approximately 2250 patients have been treated. The influence of smoking, gender, age, occupation and marital status on recovery has been studied.

Smoking: Patients who had given up smoking between the first and second questionnaires showed a significant improvement in their outcome score and MSPQ score. Out of 827 who said they smoked on presentation, 280 said they did not on review. From an average outcome score on presentation of 25, those who gave up improved more than those who did not (average score at review 37 vs. 31). A similar trend was seen in the MSPQ averages (from 9 to 7.4 vs. 9 to 8.7). Non-smokers had better results than smokers with an increased outcome score from 30 to 38, MSPQ from 8 to 7.1 and Zung from 20.6 to 19.6. Thus people who gave up smoking showed a larger improvement in their outcome and MSPQ scores than those who continued smoking and those who did not smoke at all.

Gender: Women showed greater improvement in each of the areas than men – 14.5% greater in the outcome score, a 21.2% greater increase in the MSPQ score, and 3.7% in the Zung score.

Age: Patients were divided into 10-year groups. The age group of 50–60 showed the lowest average response for each score, ( 28 to 34 on outcome (average difference = 8), 8.3 to 7.8 on MSPQ (average difference = −0.8), and 21.1 to 21 on Zung (average difference = −0.7). The 30–40 group showed the highest average change on each score (29 to 39 on outcome, 7.9 to 6.9 on MSPQ, 21.8 to 20.1 on Zung). The adjacent age groups showed similar trends but the numbers were not significant.

Occupation: Occupation was divided into eight categories from high-grade professionals to the unemployed. The least improvement was shown by the low-grade occupations (semi-skilled manual workers and the unemployed). The greatest improvements were shown by the middle grade groups. The highest grade occupation showed poor improvement but this was not significant.

Marital Status: For the outcome score, patients who were divorced/separated showed the least improvement, while the married group showed the greatest. On the MSPQ and Zung score, divorced/separated showed the greatest and second greatest improvement (61 % greater than the average on Zung score). The single group showed the worst overall response, scoring the second lowest improvement for the outcome score, the lowest on the MSPQ score (difference −0.47) and their average response actually worsened for the Zung score (from 21 to 21.6).

Conclusion: This study demonstrates that demographic and socio-economic factors significantly influence the level of improvement which patients make in their recovery from mechanical back pain after a treatment program.

The aim of this study was to test the effectiveness of a nurse practitioner-led clinic for managing the pre and postoperative care of patients undergoing lumbar spine surgery, against traditional clinic treatment.

Ninety patients were randomised- 46 (Group 1) attended a nurse practitioner run pre-operative class and post-operative follow-up clinic and 44 (Group 2) were seen by the surgeon before and after the operation. All patients completed the Low Back Outcome Score, MSPQ and Zung score, pre-operatively and at six months post-op.

There were 46 male and 44 female patients, and mean age was 45.4 years (range 20–77). The two groups were demographically similar (p = 0.418). The mean pre-op outcome score was 23.49 in group 1 and 17.41 in group 2 (p = 0.038) and the mean post-op scores were 44.67 and 35.38 for group 1 and 2 respectively (p = 0.021). Intra-group comparison showed an improvement in post-op outcome score for all patients (p = 0.001), but those in group 1 were significantly more satisfied (p = 0.008). Four theatre slots were lost in group 2 but none in group 1.

A nurse practitioner-led pre-op counselling and post-op follow-up is more effective than the traditional clinic attendance for patients undergoing lumbar spine surgery and prevented waste of theatre time.