Background. Advanced spinal practitioner physiotherapists (ASPPs) assess and manage spinal referrals, as advocated by the National Low Back Pain Pathway in the United Kingdom. The ASPP pathway relies on multi-disciplinary team (MDT) meetings where potential surgically appropriate or complex cases can be discussed. Meetings were held with two different Consultant Spinal Neurosurgeons (total 2 meetings per month). The aim of this service evaluation was to assess MDT meeting outcomes and surgical listing. Methods. This retrospective service evaluation used routinely collected MDT meeting documentation between May 2019 and October 2021. Data was extracted by two ASPPs, and 20% checked by a third ASPP. Extracted data included: number of patients discussed, Consultant, reason for discussion, and outcome (surgical listing or other). Data was analysed by two ASPPs using pivot tables in Microsoft Excel and was reported using counts and percentages across month and year. Results. The majority of MDT discussions were for a surgical opinion (n=293, 25% clinician led, n=351, 30% patient led). Of these, 46% (n=135) of clinician surgical opinions were directly listed compared to 20% (n=70) of patient led discussions. Similar rates of consultant clinic review were seen between the two groups (22% and 32%), suggesting that the majority of patients discussed for surgical consideration were appropriate. 517 (45%) were discussed for management opinion. Conclusions. This evaluation demonstrates that a majority of cases (68%) identified by ASPPs for surgical opinion were either directly listed or had consultant clinic surgical review. The results and trends identified will guide future patient pathway development and ASPP training. Conflicts of interest: No conflicts of interest. Sources of funding: No sources of funding

Background. Scoliosis is described as a lateral spinal curvature exceeding ten degrees on radiograph with vertebral rotation. Approximately 80% of scoliosis presentations are adolescent idiopathic scoliosis (AIS). Current management for AIS in the UK occurs in Surgeon or Paediatrician-led clinics and can be conservative or surgical. The musculoskeletal assessment and triage of AIS appears well-suited to an advanced physiotherapist practitioner (APP) skill set. The aim of this service evaluation was to scope, develop, implement and evaluate a four-month pilot of an APP-led AIS triage pathway. Method and Results. Spinal Consultant deformity and scoliosis clinics were scoped and observed. Clinic inclusion criteria and a patient assessment form was developed. An APP AIS clinic was set up beside a consultant led clinic. All patients assessed were discussed with a spinal surgeon. Consultant and APP agreement (% of total), waiting times, surgical conversion, and patient satisfaction were reviewed. A clinical competency package was developed for training and development of APPs. A total of 49 patients were seen (20 sessions). Waiting list reduced from 10 weeks to 6 weeks. 45%(n=22) of new patients seen were diagnosed with AIS, 27% (n=6) were directly listed for surgery. Consultant/ APP percentage agreement was high for Cobb angle measurement (82%), management plans (90%), and further diagnostic requests (94%). There were no adverse events and high patient satisfaction levels (n=20), (100% Very satisfied or satisfied) were reported. Conclusion. APP-led AIS clinics can provide similar levels of management and assessment as Spinal Consultants with improved waiting times and high levels of satisfaction. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Purpose of study. To evaluate implementation of the Back Skills Training (BeST) programme in clinical practice within the National Health Service (NHS). Background. The BeST programme is a group Cognitive Behavioural Approach (CBA) for people with persistent (≥6 weeks) low back pain (LBP). This intervention has been shown to be clinically and cost-effective in a large pragmatic trial. To aid implementation of the BeST programme, an online training intervention (iBeST) was developed. Methods. iBest was promoted through marketing activities (e.g. conferences, social media, evidence briefs) prior to release and launched in March 2016 for NHS health care professionals. Impact of iBeST is being evaluated by measuring number enrolled, course completion, implementation intention, clinical delivery, perceived competence, attitudes/beliefs towards LBP, knowledge and satisfaction. Data is collected at pre and post-training, 4 months and 12 months after course completion. A service evaluation is also being conducted to measure clinical impact. Patients taking part in the BeST programme as part of routine treatment complete questionnaires at baseline, post-treatment, 3 months and 12 months after the programme to assess pain, disability, recovery, satisfaction and usefulness of BeST. Results. 881 clinicians have enrolled on iBeST and 260 have completed training (target: 250). 28 NHS sites are delivering the BeST programme. 385 and 290 participants have provided baseline and post treatment data respectively (target: 400). Data collection is ongoing. Conclusion. Implementation is challenging but iBeST has been well received by NHS clinicians and we plan to report further results of the impact and service evaluation. Conflict of interest: None. Source of funding: This research is funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

Background and objectives. The Alexander Technique (AT) is a self-care method usually taught in one-to-one lessons. AT lessons have been shown to be helpful in managing long-term health-related conditions (Int J Clin Pract 2012;66:98−112). This systematic review aims to draw together evidence of the effectiveness of AT lessons in managing musculoskeletal (MSK) conditions, with empirically based evidence of physiological changes following AT training, to provide a putative theoretical explanation for the observed benefits of Alexander lessons. Methods and results. Systematic searches of a range of databases were undertaken to identify prospective studies evaluating AT instruction for any musculoskeletal condition, using PICO criteria, and for studies assessing the physiological effects of AT training. Citations (N=332) were assessed and seven MSK intervention studies were included for further analysis. In two large well-designed randomised controlled trials, AT lessons led to significant long-term (1 year) reductions in pain and incapacity caused by chronic back or neck pain (usual GP-led care comparator). Three smaller RCTs in chronic back and neck pain, respectively, and a pain clinic service evaluation broadly supported these findings. A pilot study reported preliminary evidence for pain reduction in knee osteoarthritis patients. Further studies showed significant improvements in general coordination, walking gait, motor control and balance, possibly resulting from improved postural muscle tone regulation and adaptability, in people with extensive AT training. Conclusion. Available evidence supports the effectiveness of AT lessons for people with chronic back or neck pain. Studies suggest some of the observed benefit may be due to improvements in movement coordination, balance and postural tone. Conflicts of interest: None. Authors are practising Alexander Technique teachers. Funding: None

Aims

With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic.

Aims

Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform.

Aims

To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS).