Background

A local authority approached us, for a cost-beneficial solution to their increasing low back pain referrals. We proposed developing a student-led clinic – an intervention delivered by students but supervised by clinicians. We then conducted scoping reviews on student-led clinics in the management of health conditions and on the self-management of back pain. The findings suggested that student-led self-management interventions for low back health should be feasible. The next step was to co-construct the intervention with key stakeholders.

Purpose

The purpose of this study was to discover if student led clinics (SLC) are feasible delivery mechanisms for Low back pain (LBP) self-management support and to develop a service model.

Background

Current policy and practice aimed at tackling work disability due to low back pain is largely aligned with the Psychosocial Flags Framework, which focuses on addressing individual beliefs and behaviours (yellow and blue flags). However, our understanding of the systemic and contextual factors (black flags) that are also proposed to act as obstacles within this Framework is under-represented, resulting in a disproportionate evidence base and suboptimal interventions.

Background

Individual illness perceptions have been shown to be important influences on both clinical and work outcomes for those with back pain, yet the influence of ‘significant others’ (spouse/partner/close family member) illness perceptions is rarely explored, particularly in relation to work participation.

Background

Individual illness perceptions have been shown to be important influences on clinical outcomes for low back, yet significant others' illness perceptions are rarely explored, particularly in relation to work disability.

Objective: To improve the quality of prospective cohorts studying the transition from early stages of back pain to persistent problems, in order to allow researchers to improve the predictive quality, and pool data from multi-centre studies.

Summary of background: The progress from early stages of back pain to persistent problems is poorly understood, and only a fraction of the variance at outcome can be accounted for by current prospective cohorts. Standardization of a core set of factors would allow pooling and facilitate comparison between studies.

Method: Teams from 12 nations with expertise in clinical practice, prospective cohorts, epidemiology, social sciences, and health services were appointed.

The steering committee produced checklists of predictors and outcomes based on systematic reviews and a Delphi focus group. The international teams of experts coded each item for inclusion or exclusion, and recommended new items. This process was iterated twice to resolve disagreement between teams, and to receive scores for new items. The steering committee carried out a consensus synthesis and produced the final lists for predictors and outcome. Finally, the measurements for each factor were selected based on:

original systematic review

Results: The checklist for predictors include information about demographics, clinical status, psychosocial status, work, and the first consultation for back pain. The recommendation for outcomes include pain, disability, return to work and sick leave, satisfaction, psychological factors, health care utilization and treatment over the follow up period.

i Background and Purpose. Typically systematic reviews and guidelines consider chronic and acute/sub-acute back pain (< 3 months). However, LBP’s clinical course is often untidy, making this distinction difficult to apply in practice. We did a secondary analysis of the UK BEAM data-set to decide pain duration affected treatment outcome.

ii Method and results: We recruited 1,334 participants with four weeks or more of LBP to a trial of manipulation and exercise for low back pain. We found small sustained benefit from the manipulation package and a small short term benefit for the exercise package. One third of our participants reported that their pain had lasted for less than 90 days (range 4 weeks to 40 years). For this analysis the dependent variable was the Roland Morris Disability Questionnaire score at 12 months. Independent variables were treatment group and episode length, an interaction term between treatment (usual care, exercise, manipulation, and manipulation followed by exercise) and duration of current episode. Preliminary analysis indicates that the significance of the interaction terms for manipulation vs GP care, exercise vs. GP care and manipulation followed by exercise vs GP care are, 0.409, 0.037 and 0.889 respectively. The statistically significant result for the interaction between exercise and episode duration is a positive interaction, indicating that exercise may be more effective for those with shorter episodes of back pain and GP care more effective for longer episodes.

iii Conclusion: It is possible that duration of episode affects effectiveness of the UK BEAM exercise package, but not the UK BEAM manipulation package.

Study design: Cross-sectional questionnaire-based workforce survey together with collection of retrospective data on work absence.

Objectives: To determine if psychosocial ‘blue flags’ are related to back pain and/or sickness absence due to back pain.

Summary of background: The original description of the psychosocial ‘yellow flags’ for back pain chronicity included a mixture of individual psychological parameters and parameters related to perceptions about work and the workplace. It has recently been suggested that these latter parameters should be considered separate and distinct from the individual parameters , and can be termed ‘blue flags’. To date, however, there has been no attempt to explore the specific relationship between the blue and yellow flags or their relative relationship to symptoms and disability.

Methods: The workforce of a large multi-site company was invited to complete a booklet of questionnaires, which included the standard Nordic instrument for obtaining back pain data, and specific instruments to obtain data on ‘yellow’ and ‘blue’ psychosocial flags. The blue flags included psychosocial aspects of work, attribution and elements from the demand/control model, with psychological distress used as a yellow flag comparator. Of the 7,500 workers, 60% responded. Sickness absence records identified workers who had taken absence for back pain. The exploration of the data involved determining statistically significant relationships between psychosocial scores and both back pain history and absence. Appropriate statistical procedures were then used to establish cut-off points for the psychosocial variables. Odds ratios were calculated for two particular outcome variables: self-reported back pain in the previous 12 months and recorded absence over the same period.

Results: Cut-off points were established for each variable, along with the odds ratio (OR) that this score or a score above or below (depending on the scale direction) is associated with reports of back pain or absence. The ORs for psychological distress were 1.9 and 2.4 respectively for LBP and absence in the last 12 months. The ORs for the blue flag variables varied from 1.1 to 1.5 for LBP and from 1.8 to 3.2 for absence.

Conclusions: The psychosocial blue flags reported here are statistically significantly related both to reported back pain and absence. The effect size is less than that for distress in respect of back pain, but variously higher and lower for absence. Whilst prospective studies are needed to determine cause/effect, the results offer tentative support for the suggestion that blue flags should be addressed in clinical interventions.