1. Post Course Self-assessment and Next Steps Garey Mazowita, Julia Alleyne

2. 2  List serv: l_hlth_psp_msk  Support calls: Friday, June 14 and September 20  Train the Trainer 2: October 23, 2013 Next Steps

3. 3 1.Morning Stiffness less than 30 minutes 2.Pain associated with movement such as bending 3.Occasional night waking with moderate pain 4.Urinary retention followed by overflow incontinence 5.Intermittent pain with lumbar extension Which key clinical features are NOT suggestive of Mechanical Low Back Pain ?

4. 4 1. Presence of chronic back pain not responsive to conservative treatment after 8 weeks 2. Presence of non-radicular referred leg pain 3. Presence of tingling sensation in affected leg 4. CT/MRI indicating any disc pathology 5. CT/MRI indicating clinically significant nerve root compression 6. Clarification of work related modifications and restrictions 7. Patient would like second opinion on diagnosis and management In the absence of red flags, what are the most common reasons for you to refer your patient with Low Back Pain to a spinal Surgeon?

5. 5 1. Vegetative signs of clinical depression 2. Fear and avoidance of activities associated with discomfort 3. Frequent disruptive sleep disturbance 4. Dependency on passive pain management modalities 5. 1 and 2 6. 2 and 4 7. All of the above A patient who demonstrates positive yellow flags would fit the following behaviours

6. 6 1. Acute low back pain of 1 week duration in avid athlete 2. Persistent low back without response to medication and exercise 3. Use of lumbar traction for chronic low back pain 4. Low back pain triggered by a motor vehicle accident In which of the following situations would the low back pain guidelines recommend goal-specific rehabilitation?

7. Action Planning Connie Davis

8. 8 Action speaks louder than words but not nearly as often. Mark Twain 8

9. 9  Clear Goals (written down)  A way to measure our progress  Defined changes to try What will lead to our success

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11. 11 We aim to improve the quality of care and support for patients living with RA, OA and Low Back Pain in GP offices. We will know we have improved when we see: › A reduction in pain › An increase or reduced decline in functioning › Informed and activated patients managing their condition to the best of their abilities › Specialist support and consult available in a timely manner when needed What are we trying to accomplish?

12. 12 From “difficult” and “painful” to “in control” and “informed” Basically…

13. What is Your Goal?

14. 14  Which condition do you want to start with?  OA, RA, and LBP Algorithms  Clinical and diagnostic tools  Reference tools  Patient Tools  Community Linkages Find a full listing in your action planning template! What do you want to focus on?

15. 15  Linkages to other resources – who and how  Information – logical, orderly comprehensive  Assessment and referral for emotional problems or work issues  Help to make sense of test results; what does that mean for me?  Strategies for self management  Referral to other heath providers as needed  Non-pharmacological pain management strategies  Contingency plans What did patients say they needed?

16. 16 All conditions:  % of patients who have been engaged in a self management conversation in the past 12 months in the GP office.  % of patients who have had an assessment of pain and functioning in the last 12 months.  % patient who have received Pharmacological and non- pharmacological interventions as required to for pain.  % of patients who have received education on treatment, self management and lifestyle. How will we monitor our progress?

17. 17 *Each condition has 1-2 condition specific measures related to best care guidelines. Disease specific Measures

18. 18 How do you eat an elephant? Testing Improvement

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20. 20 Step 1 Try patient Questionnaire with one OA patient. Step 2 Change the timing of the questionnaire, and try it with another patient Step 3 Change how you review results and try again Step 4 Try new process with all OA patients for a week. Start Small and GROW

21. 21 Ask those in the know! When in doubt…

22. 22  Lulu IslandFraser Health  BridgeportInterior Health  Gulf of GeorgiaNorthern Health  Steveston AVancouver Coastal  Steveston BVancouver Island Action Planning Breakout Rooms