Consultation Report
Back pain is one of the most common health problems affecting society, with up to 70% of the population experiencing pain at some point in their lifetime. It is associated with significant healthcare use and societal cost in terms of work loss and disability, and has been addressed using a variety of management approaches.
Where possible, this HTA focused on evidence relating to non-specific acute low back pain. Non-specific low back pain has no specific pathology, commonly has a mechanical cause and varies with posture and over time. Acute low back pain is often associated with tissue damage, with symptoms usually resolving spontaneously within 6 weeks. However, symptoms may persist and recur in the long-term.
Early intervention is considered critical to the management of low back pain to ensure that treatment occurs during the acute phase, before the condition deteriorates and becomes chronic. An acute low back pain service delivery model represents a time-efficient approach to help patients with back pain control their symptoms, while remaining active and avoiding loss of usual daily functioning. Various different service models are in use, or have been proposed, to ensure prompt and appropriate diagnosis, management and treatment of acute low back pain. These models vary in their provision of referral management systems, referral authority, use of extended scope practitioners and the availability of prompt access and treatment modalities.
Objectives of the Health Technology Assessment
The objectives of this HTA were:
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to consider the clinical and cost effectiveness of service delivery models for the management of acute low back pain which utilise different triaging referral models.
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to assess the impact of various parameters on a service delivery model to optimise its clinical efficacy and cost effectiveness.
This HTA focused on non-specific acute low back pain, where it was possible to distinguish this condition in the supporting literature.
Methods
The scientific literature was systematically searched to identify evidence of the clinical and cost effectiveness of service delivery models for the management of acute low back pain. Experts, professional groups and other interested parties were also invited to submit evidence. All evidence was critically appraised. A survey was undertaken to ascertain current service provision for low back pain services in Scotland.
Results and Conclusions
Systematic review of the scientific literature found a paucity of evidence to inform the organisation of low back pain services in Scotland. Consequently it has not been possible to undertake an economic evaluation of different service delivery models or to recommend a specific model for the organisation of low back pain services to NHSScotland. However, this report highlights the existing evidence for the treatment of low back pain which NHS boards should consider when developing services. This includes the Prodigy and European guidelines and other publications. This is supported by the work on patient issues, which identified adherence to guidelines as being of significant concern.
Recommendations
Although this HTA is unable to make recommendations for clinically and cost effective models of service delivery for low back pain in Scotland, a number of secondary recommendations are made:
1. NHS Boards should take account of existing evidence based guidelines and advice for the management of low back pain.
2. Any redesign of services for low back pain in Scotland should include an evaluation element
3. Any evaluation of service redesign should incorporate consideration of both clinical and cost effectiveness and should use validated clinical outcome measures
4. Patient issues should be addressed as part of any service redesign.