Core Low Back Tool Dr. Julia Alleyne BHSc(PT) MD MScCH Dip Sport Med CCFP(SEM) FCFP Code Spine March 2018

Faculty / Presenter Disclosure Disclosure of Commercial Support Faculty: Dr. Julia Alleyne Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: Centre for Effective Practice, Tool Development, Not for Profit Organization, Free tool -Other: None Disclosure of Commercial Support This program has not received financial support. Potential for conflict(s) of interest: There is no payment or funding for this program. All Tools are available at no cost through the public domains of many organizations who have endorsed the tool. MSK CONNECT - WEEK 1

Primary Care Provider Dealing with complex and chronic LBP Patient expectations for MRI & referrals Psychosocial patient needs Lack of patient educational resources Lack of tools in guideline recommendations Work related restrictions Medication (Opioid Management)

Patient Barriers Lack of understanding of rationale for investigations and specialist referral Desire for funding for physiotherapy Lack of self-management strategies Request for more medications Request for time off work Lack of understanding of urgent symptoms versus pain Lack of education on etiology of low back pain Access to medical appointments

System Barriers Poor communication between providers Lack of coordinated patient education material Lack of web resources Lack of consensus on guidelines Lack of common approach between providers assessment and treatment

Gap Analysis of Current Guidelines Includes: Continuum specific Key Messages Red Flags Yellow Flags Investigations Referrals Medications American College of Physicians and was endorsed by the American Academy of Family Physicians. Towards Optimizing Practice, Alberta New Zealand Yellow Flags

Gap Analysis of Current Guidelines Includes: Continuum specific Key Messages Red Flags Yellow Flags Investigations Referrals Medications Lacks Approach to Assessment Clinical Tools Office Strategies Patient Specific Approach

Give us one tool !

CORE LOW BACK TOOL

Range of Motion Identify Current Pain VAS Move Is your pain Better Worse Unchanged

Prone Extension Arms push up Buttock relax May use pillow to support pelvis 5-10 Repetitions Looking for pain improvement

Passive Hip Range of Motion

Passive Straight Leg Raise

Femoral Nerve Stretch

Myotomes Knee Extension Ankle Dorsiflexion Great Toe Extension Great Toe Flexion

Complete your Neuro Deep Tendon Reflexes Dermatomal Sensation Babinski Reflex

Evaluating Response to Treatment Pain Improves Reduce pain medication Reinforce appropriate activity/exercise Increase exercise /return to activities Follow-up at patient’s discretion Pain Unchanged Re-assessment Flags & Pattern Review Activity/Exercise Technique/ Dose Pain Aggravation Schedule recovery Review Medication Dosing/ Consistency/ Side Effects Consider Rehab referral Follow-up in 3-7 days to determine response Pain Worsens Flags & Pattern (Evolving or Combination) Consider imaging/referral Yellow Flags - ? CBT Consider Non-Mechanical Low Back pain diagnosis If above is negative, refer to Unchanged column

Reasons for referral to a spinal surgeon Appropriate reasons for referral Inappropriate reasons for referral

Comfort with Assessing & Managing LBP Consistent increase in comfort as a predictor of behavior

Confidence in Assessing & Managing LBP Consistent increase in confidence as a predictor of behavior 15% 18% 20% 22%

Saskatchewan Spine Pathway

BCMA Practice Support Program

www.thewellhealth.ca