Implementing evidence-based primary care for back pain (IMPACT BACK)

Back pain accounts for around 10% of GPs’ appointments. This project worked to improve the care of people with back pain by training GPs and physiotherapists to identify which treatment is most appropriate for different types of patients and how to deliver that treatment.

The project team developed a technique for dividing patients into three types, along with a training programme to train physiotherapists to deliver different interventions for each group. This was based on the knowledge that, for example, people with pain and disability will respond to various manual techniques of physiotherapy and people with psychological distress may need a cognitive psychological approach.

This approach was delivered in GP practices and community physiotherapy centres in the Central and East Cheshire PCT:

• More than 900 patients, 65 GPs and 34 physiotherapists took part in the project.
• Practice staff were trained in the use of a questionnaire and in using different prompts to ensure high uptake.
• Physiotherapists underwent additional training for three to nine days to deliver different types of treatments and were then mentored over 12 months.
• GPs received best practice updates and regular feedback.

The project measured how effective the treatments were, asking patients how much they had benefited. It also sought to measure changes in clinicians’ attitudes, beliefs and practice.

Benefits

• The project helped focus on outcomes that patients regard as important and measure whether these had been achieved.
• The physiotherapy interventions the team have developed have the potential to be incorporated into accredited post-graduate training and influence national guidelines and health policy on low back pain.
• The project saw changes in the attitudes and confidence of GPs and physiotherapists and improvements in patients’ disability outcomes.