Introduction: The purpose of this research is to use an anthropological approach to examine the narratives of individuals living in Teesside, who have been diagnosed with mechanical back pain at a nurse led Spinal Assessment Clinic. The narratives that people use to construct their back pain must be taken into account if they are to be helped, as their beliefs about their problem will impact upon their expectations and compliance.

Method: After their first appointment in the Spinal Assessment Clinic, individuals who were diagnosed with mechanical back pain were invited to join the research. Each individual was interviewed three times as they progressed through the clinic system. The second time was after they had or had not attended the back pain management classes. The last interview was after their final review and they were discharged from the clinic. The interviews were casual with very little input from the researcher.

Conclusion: Individuals appear to have a hidden agenda when they attend the clinic and this helps them to decide whether to accept or dismiss their diagnosis. The narrative used by the multidisciplinary team is interpreted according to each persons agenda often leaving individuals with a totally different interpretation to that intended by the multi disciplinary team. People appear to tell clinicians what they think they want to hear, but during their interviews for this research different narratives often emerged.

Listening to people’s life stories and examining the narrative they use to explain their back problems can enable the multi disciplinary team to better understand individuals and their problems and assist in their own professional development as well as improving services for patients.

Introduction: A Health Action Zone project has been designed to assess the effect of a public education programme to improve the community awareness of the correct approach to low back pain. As part of this project a preliminary survey of the public has been undertaken.

Methods: 195 members of the public were surveyed using by a number of members of the team using a pro-forma. Interview sites were selected to provide a cross section of the population of the community. Demographic details were collected together with data related to low back pain prevalence and attitudes to self management.

Discussion: The initial survey shows that people take too much rest and do too little exercise. The HAZ projects, which have been in existence for three years, have had small penetrance into the community. The Teesside Back Pain Partnership so far has focussed on individual education as part of other strategies. A radio, bus posters, leaf ets and posters campaign aimed at changing beliefs on back pain management. the pattern of behaviour is planned. The extremely low level of awareness of the TBPP will provide an opportunity to measure how much of any change may be attributed to this campaign.

Study background: The management of patients presenting in primary care with a “new episode of back pain” using the RCGP guidelines by a nurse practitioner (NP) compared to a control group given ‘usual care’ by the GP.

Methods and Results: The evaluation includes sequential monitoring of LBOS, audit of documentation for both groups of patients to assess application of guidelines and patient recall of key information.

Conclusion: The NHS Plan (2000) called for national standards for treating all major conditions in “Shifting the Balance of Power- the next steps” (2001) a clear criterion is that “service outcomes which provide better and better validated information” will form part of the performance rating. These two documents highlight the need for more user and client involvement in service development but this needs to be carefully monitored and linked to effective evidence.

This study demonstrates that the NP documentation follows the guidelines identified by the RCGP, conversely it was not possible to assess from the GP documentation if all the steps had been followed. The mean average LBOS in the NP patients was slightly higher than those in the GP group, was this because these patients were having guideline applied care as opposed to “usual care”?

Evaluation of the patient recall of information shows the NP sent five patients for X-ray even though this did not occur and is not recommended in guidelines. Conversely twenty-three patients can remember being given the “Back Book” by the GP but this was only documented in three cases.

We believe that patient recall demonstrates an ineffective way to measure outcome and funding allocation for back pain management and needs to more accurately reflect the evidence.

Aim: Examine how individuals on Teesside, diagnosed with mechanical back pain, socially construct the beliefs they hold about their back problem. The Spinal Assessment Clinic, at Middlesbrough General Hospital, uses a comprehensive and co-ordinated approach when assessing and treating individuals. More information demonstrating how people suffering with mechanical back pain are influenced by their psychosocial and cultural beliefs would enable the team to enhance the process. This research, is an anthropological examination of individual’s thoughts and beliefs as they absorb the information extended to them. This will be valuable in enhancing clinicians, sufferers and academics understanding of back pain. The research is still in the recruitment phase.

Method: This is an ethnographic study using a phenomenological framework to interpret the narrative and pictorial accounts given by individuals suffering with mechanical back pain as they proceed through their treatment at Spinal Assessment Clinic. Interviews are informal, the intention being to listen to each individuals life story and explore the way in which the narratives evolve, as they explain the lived experience of their pain.

Individuals are being recruited from the Spinal Assessment Clinic. One of the research methods utilised is that of pain imagery, with volunteers providing a drawing, representing their back pain.

Results: The drawings demonstrate that physical pain is not always viewed by individuals as a biological problem, it may be externalised or expressed as an emotion. The images are filled with vivid metaphors symbolising each individuals unique interpretation of their pain.

Conclusion: Initial results demonstrate there is a gap between the patients’ visualisation in their drawing and the narrative accounts provided.

The aim of this study was to compare implementation of RCGP guidelines in patients in Primary Care with acute low back pain between GP and Nurse Practitioner. This report presents preliminary results.

The intention was to recruit 200 patients presenting to GP with new episode of back pain. 50% randomised to NP care, 50% to GP care. Outcome measured by documentation audit and patient feedback. Individuals complete a questionnaire which includes a Low Back Outcome Score (LBOS) at 14 weeks, 6,12 and 24 months. All patients in NP arm given back book and advised against bed rest.

Initial Findings: (n = 145): The LBOS score was identical (30) for the 73 patients randomised to nurse practitioner care and the 72 with routine GP care. There were no significant differences between the scores at 14 weeks and 6 months, with an increase in LBOS to 45–49, but numbers dropping to 28 in the NP group and 26 in the GP group.

Process audit at 14 weeks: Only 10 of NP patients were not given the back book compared with 74% for GP care. 13% of NP patients were prescribed bed rest against 18 for GP care.

Initial results suggest no significant difference in outcome between GP and Nurse Practitioner patients. Of interest is that 10% and 13% of patients failed to recall important features of management. This implies that audit of healthcare processes by patient questionnaire may be unsatisfactory.