Purpose and background. Low back pain burdens individuals, society and services, including Emergency Departments (ED), straining services and prolonging wait times. Despite reported personal influences on deciding to attend ED, the role of third-party advice remains underexplored. Sparse guidance for clinicians and service-users highlights the need for effective back pain management strategies, to alleviate system pressure and optimise patient outcomes. This study explored how advice influences the decision to attend the ED for back pain. Methods and Results. From a subtle realist stance, the design was a secondary analysis of qualitative data, where 47 patients (26M:21F, aged 23–79 years) with back pain were purposively sampled from four EDs (2 Northern and 2 Southern) in England between August and December 2021. Eight patients had previously visited ED for this episode of back pain. As this was during the pandemic, semi-structured interviews were conducted online, audio-recorded, transcribed verbatim and analysed using a reflective thematic analysis. Three themes were identified as crucial in making the decision to attend ED: The Healthcare professional; Trusted others; and the Individual. Healthcare professionals often dictated decisions, leaving participants feeling powerless. Trusted others provided varying support levels, often acting as allies. Individuals grappled with anxieties around their condition and treatment expectations. Conclusion. This study highlights the need for clinicians to provide clarity and guidance to individuals and their Trusted others, seeking advice regarding escalation to visit the ED with back pain. There was evidence that worrying about pain was a significant motivator for attending ED, resulting in malalignment with current practice guidelines. No conflicts of interest.  . Sources of funding. Funding for primary data: Health Education England & National Institute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)

Background. Chronic pain is a significant burden and represents a major issue for world healthcare systems. Interventions include medication, surgery, pain management programmes, and social support through peer support groups. These groups are often informal, providing informational, emotional, and social support to members. The aim of this project is to co-produce guidance on how to establish a peer support programme for people living with chronic, non-cancer pain that is informed by evidence, theory, and stakeholder experience. Methods. This project is using Steps 1–4 of the Intervention Mapping (IM) approach to inform the research. Online workshops consisting of people living with chronic pain, third sector representatives, healthcare professionals, and researchers are being used to co-produce the guidance. Results. To date, 2 of the 4 planned workshops have been conducted. These have identified the needs of people living with chronic pain, goals for the peer support programme, and expectations of how a peer support programme should be executed. Topics for inclusion in the programme and their content have been identified, with further workshops to refine this planned. The final stage of this project will identify methods of delivery, specific resources that should be developed, and the training to be provided to peer support volunteers. Conclusion. The project has identified the diverse needs of people living with chronic pain and how these may be addressed by a peer support programme. It has identified flexible options that can be recommended to those who want to set up a programme and a variety content that may be included. Conflicts of Interest. None. Sources of Funding. Robert Gordon University

Introduction. The aim of this study was to assess patients and healthcare professionals (HCPs) opinions on the validity of using a biopsychosocial model rather than a biomedical model in alleviating patient symptoms/pain. Method. We constructed a questionnaire to assess beliefs on the effectiveness of using a biopsychosocial or biomedical model to develop a treatment plan to optimise patient symptoms/pain. We distributed the questionnaire to new and follow-up patients and healthcare professional in the orthopaedic department. Results. 246 questionnaires were completed - 183 patients and 63 HCPs. The patient group consisted of 77 males and 106 females, the HCP group of 27 males and 36 females. 77(42%) of patients and 9(14%) of HCPs agree the biomedical model is best suited to treat symptoms. 81(44%) of patients and 62(98%) of HCPs agree the biopsychosocial model is best suited to treat symptoms. 70(38%) of patients and 61 (97%) of HCPs agree stress can increase pain. 87(48%) of patients and 62(98%) of HCPs agree distress can increase pain. 83(45%) of patients and 56(89%) of HCPs agree stress can increase disability. 81(44%) of patients and 56(89%) of HCPs agree distress can increase disability. 39(21%) of patients and 43(68%) of HCPs agree if all investigations show no abnormality in explaining symptoms, the main contributor is stress, distress or psychological/socioeconomic factor. Conclusion. HCPs recognise the biopsychosocial model as a useful tool in managing patients pain/symptoms which not recognised by patients. HCPs believe that stress, distress, psychological/socioeconomic factors have a significant impact on a patients pain and disability when compared to patients. No conflicts of interest. No funding obtained

A Core Outcome Set (COS) for treatment of adolescent idiopathic scoliosis (AIS) is essential to ensure that the most meaningful outcomes are evaluated and used consistently. Measuring the same outcomes ensures evidence from clinical trials and routine clinical practice of different treatments can be more easily compared and combined, therefore increasing the quality of the evidence base. The SPINE-COS-AYA project aims to develop a gold standard COS which can be used internationally in research and routine clinical practice to evaluate the treatment (surgical and bracing) of AIS. In this qualitative study, the views of adolescents and young adults with AIS (10-25 years of age), their family members and healthcare professionals in a UK region were sought, via interviews, on treatment outcomes. Participants were purposively recruited from a variety of sources including NHS outpatient clinics and social media. Semi-structured interviews were analysed using thematic analysis. Key findings will be presented, to include potential core outcome domains identified by the different subgroups. The core outcome domains identified in this research programme will subsequently form part of an international consensus survey to agree a COS. In future, if the COS is used by healthcare staff and researchers, it will be easier for everyone, including patients and their families, to assess which treatment works best

Background. Involving research users in setting priorities for research is essential to ensure research outcomes are patient-centred and to maximise research value and impact. The Musculoskeletal (MSK) Disorders Research Advisory Group Versus Arthritis led a research priority setting exercise across MSK disorders. Methods. The Child Health and Nutrition Research Initiative (CHRNI) method of setting research priorities with a range of stakeholders were utilised. The MSKD RAG identified, through consensus, four research Domains: Mechanisms of Disease; Diagnosis and Impact; Living Well with MSK disorders and Successful Translation. Following ethical approval, the research priority exercise involved four stages and two surveys, to: 1) gather research uncertainties; 2) consolidate these; 3) score uncertainties using agreed criteria of importance and impact on a score of 1–10; and 4) analyse scoring, for prioritisation. Results. The first survey had 209 respondents, who described 1290 research uncertainties, which were refined into 68 research questions. 285 people responded to the second survey. The largest group of respondents represented patients and carers, followed by researchers and healthcare professionals. A ranked list was produced, with scores ranging between 12 and 18. Key priorities included developing and testing new treatments, better targeting of treatments, early diagnosis, prevention and better understanding and management of pain, with an emphasis on understanding underpinning mechanisms. Conclusions. For the first time, we have summarised priorities for research across MSKD, from discovery science to applied clinical and health research, including translation. We present a call to action to researchers and funders to target these priorities. Conflict of Interest: None. Sources of funding: We thank the funder, Versus Arthritis for their support of the research advisory groups and this activity

Background. Chronic musculoskeletal pain increases an individual's risk of developing many chronic diseases and the risk of all-cause early mortality. There is irrefutable evidence supporting the role of physical activity (PA) in reducing these risks. Sustaining changes to PA behaviours is challenging and efforts are needed to understand the barriers and facilitators of change. Understanding these factors is a vital step in developing behaviour change interventions. Objectives. Explore barriers and facilitators to engaging in PA in adults accessing pain services. Explore barriers and facilitators to promoting PA by healthcare professionals, exercise professionals and charity staff/expert patients. Methods. A qualitative study using the theoretical domains framework (TDF). Two focus groups were conducted with service users (n=18). Three focus groups were held with; healthcare professionals (n=8); exercise professionals (n=6) and charity staff/expert patients (n=8). Two independent reviewers thematically analysed transcripts. Barriers and facilitators were subsequently coded according to the domains of the TDF. Results. For all groups barriers were frequently mapped to the domain ‘environmental context and resources’. Although there was variation across the groups, barriers were also frequently mapped to the domains of ‘knowledge’, ‘beliefs about consequences’, and ‘belief about capabilities’. For service-users' facilitators were frequently mapped to ‘social influences’. Conclusion. The TDF was used to identify deficits that are likely to influence behaviours; targeted intervention strategies have been developed to specifically target these deficits. The interventions that have been developed consider not only the behaviour of those at whom the intervention is targeted, but also those involved in its delivery. No conflicts of interest. Sources of funding: This research was funded by the Public Health Agency, HSC R&D Division through a Doctoral Fellowship awarded to J Marle

Background. Information about low back pain (LBP) and help to support patients' self-management are recommended in the majority of guidelines for LBP management. However, the delivery of patient information and advice can be time consuming, and with short available consultation times for general practitioners (GPs), new methods to support the delivery of sufficient patient information is called for. Purpose. To identify general practitioners' perspectives on recommending online information to patients with LBP. Methods. Danish GPs varying in age and professional interests were recruited to interviewing in their practices (their working environment). The interviews were based on a semi-structured interview guide, based on a value-led method, and inspired by think aloud methods,. Results. Eight 60-Minutes interviews were conducted. For GPs to recommend online LBP information, it is essential to target the information to their patients. GPs expressed the possible advantages by involving both healthcare professionals and patients in the development of the online information material by aligning the content with the face-to-face delivered information. Furthermore, the content should be guideline concordant. However, GPs expressed that some patients had problems with accessing and understanding health-related LBP information. Conclusion. When developing online information, the content should be supported by evidence and it is important to involve patients' and GPs' preferences in the design process. Consequently, including the elements in evidence-based medicine. However, GPs do not consider online information material to be suited to all. No conflicts of interest. Sources of funding: Funded by ARs' Honour in Medical Research from Magda and Svend Aage Friederichs Memorial Fund and the Novo Nordic Foundation

Purpose. This research project explored the experiences, attitudes, beliefs, and perceptions of healthcare professionals (physiotherapists and orthopaedic surgeons) and people with chronic low back pain (CLBP) regarding the barriers and facilitators to activity normalisation following physiotherapy. Methods. A qualitative study of the perspectives of patients, physiotherapists and orthopaedic surgeons on CLBP was undertaken in Saudi Arabia. One focus group discussion was conducted with seven patients who had received physiotherapy for CLBP, along with one focus group discussion with eight physiotherapists and seven individual interviews with orthopaedic surgeons. The focus group discussions and interviews were transcribed and analysed using framework analysis. Results. We identified seven factors facilitating or hindering activity normalisation following physiotherapy: symptom control, patient education and awareness, adherence to treatment plan, psychosocial factors, role of the clinician, social support, and issues relating to the healthcare system. Conclusion. Clinicians stressed the importance of exercise and regular activity in spite of pain as an important factor hindering activity normalisation. Patients appreciated reassurance and advice from clinicians but also noted that conflicting and ambiguous advice and diagnosis was common. This may contribute to poor adherence with advice and exercise. Fear of pain and recurrence of injury were highlighted as important factors hindering activity normalisation, particularly since some patients did not take active steps to control pain. Finally, whilst multidisciplinary teams may support patient recovery and activity normalisation, this is often expensive and intensive and may be beyond the reach of a healthcare system without a properly functioning referral system and insufficient specialised clinics and physicians. Conflicts of interest: None. Sources of funding: This research was supported through a PhD scholarship from Prince Sattam bin Abdulaziz University, Saudi Arabia, at the University of Nottingham, United Kingdom

Background. Work disability due to low back pain (LBP) is a global concern, resulting in significant healthcare costs and welfare payments. In recognition of this, recent UK policy calls for healthcare to become more ‘work-focused’. However, an ‘evidence-policy’ gap has been identified, resulting in uncertainty about how this is to be achieved. Clear, evidence-based recommendations relevant to both policy-makers and healthcare practitioners are required. Methods. A policy theory approach combining scientific evidence with governance principles in a pragmatic manner was undertaken. This entailed extracting evidence from a recent review of the system influences on work disability due to LBP* (focused specifically on the healthcare system) and appraising it alongside the most recent review evidence on the implementation of clinical guidance, and policy material aimed at developing work-focused healthcare. Results. It was found that further resources are needed to assist healthcare professionals (HCPs) to engage in work discussions with LBP patients, which can often be complex and challenging. HCPs themselves often have misconceptions about the work-health relationship and the related evidence-based guidance. System-level barriers that reduce access to suitable healthcare at the right time, and those that increase conflict with other key stakeholders (e.g. the workplace and welfare/compensatory systems) were found to be significant obstacles. Supportive policy and legislation that (a) embeds work as a health outcome, and (b) enables all key stakeholders to collaborate would be a major vehicle to facilitate work-focused healthcare for LBP. Conclusions. Accepting that work-focused healthcare for LBP is required does not diminish the challenge it presents. Evidence-based recommendations relevant for both policy and practice would enable a better understanding of what works for whom, and at what cost. *A full description and results of the evidence synthesis were presented at the Society's Annual Meeting 2016 and will be presented at the 15th International Forum for Back and Neck Pain Research in Primary Care 2017. These results also form part of a chapter in ISSLS Online Textbook 2017. Conflicts of interest; None. Sources of funding: None

Aims

Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.

Aims

The aim of this study was to evaluate improvements in the quality and safety of paediatric spinal surgery following the implementation of a specialist Paediatric Spinal Surgical Team (PSST) in the operating theatre.