Physio Charlie

STarT Back screening Tool

noreply@blogspirit.com () — Fri, 06 Nov 2009 10:10:00 +0100

STarT back screening tool on the iCSP web

Added by: camilla
Posted: 17 August 2009 10:30

Hi,
I have noticed that this screening tool has been added as a document to the site. Is anyone able to give more details on when this would be used? Is there anymore guidance for if an individual scores as high risk?
Thanks,
Camilla

Showing 1 to 3 of 3

Title:	Message for iCSP Moderators
Added by:	icspteam
Posted:	27 October 2009 12:18

Hi
I noticed that the document titled STarT back screen tool has been referred to in this discussion. Just to assist you further please click on the link below which will take you directly to the discussion.

STarT screeding tool

I hope that you find this useful.
Kind regards
iCSP Team

Title:	tool
Added by:	camilla
Posted:	27 October 2009 12:10

Thanks for your detailed response Gail.
Camilla

Title:	STarT back screening tool
Added by:	gailsowden
Posted:	19 October 2009 13:02

Hi,

The STarT back screening tool is being used in various ways.

1. Over the phone as part of Physiodirect screening

2. Face to face in order to determine who is at low, medium or high risk of disability and therefore to allocate patient to different treatments.

3. At various points in clinical pathways to help with clinical decision making.

There is a version for back pain, one for musculoskeletal problems and it is being developing it into an outcome measure as well. It has also been translated into various languages.

There is a STarT back website - www.keele.ac.uk/startback

Jonathan Hill is the person to speak to for more information about the tool- pra36@keele.ac.uk

In terms of what to do with high risk patients, we think a CBT/biopsychosocial approach to adress modifiable risk factors is needed. One of the below references is for an RCT using the STarT Back tool and just such an approach.

I was one of the team that developed and delivered the training and mentoring package for this and we have developed it into an M level module at Keele university - The management of Complex Musculoskeletal patients using a Biopsychosocial approach.

Key references:

1. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 2008;59(5):632–41
http://www3.interscience.wiley.com/journal/118902658/abstract

2. Jonathan C. Hill *, Kate M. Dunn, Chris J. Main, Elaine M. Hay. Subgrouping low back pain: A comparison of the STarT Back Tool with the Örebro Musculoskeletal Pain Screening Questionnaire. Eur J. Pain 2009; doi:10.1016/j.ejpain.2009.01.003
http://www.europeanjournalpain.com/article/S1090-3801(09)00006-8/abstract

3. E Hay, K Dunn, J Hill, M Lewis, E Mason, K Konstantinou, G Sowden, S Somerville, K Vohora, D Whitehurst and C Main. A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol . BMC Musculoskeletal Disorders April 2008, 9:58
http://www.biomedcentral.com/1471-2474/9/58

Hope that helps.
Gail Sowden

Outcome Measures

noreply@blogspirit.com () — Thu, 05 Nov 2009 22:39:50 +0100

This was recently posted on iCSP:

Outcome Measures

Added by: rfergusonthomas
Posted: 28 October 2009 12:31

We have been asked to look at implementing an outcome measure that can be used from acute in-patient stay, through to intermediate care and then onto the domiciliary setting. As you can imagine this has stirred up a huge debate as to relevance, validity, etc so I was putting this out there to see if it something that has been done in other parts of the country?
The commisioners are wanting something that will measure patient satisfaction (with their outcomes/achievements, not the services involved) but we also feel we need to look objectively at the changes that occur. It needs to be multi-agency (health and adult community care) and multi-disciplinary and so needs to be easily understood and administered with inter-rater reliability.
I would appreciate any pointers!
Thanks,
Rhiannon

Title: euroquol
Added by: bwre002
Posted: 30 October 2009 08:38
Have you looked at euroquol? It has its own website - google it. Very generic so might be useful.
Title: Outcome measures
Added by: laurenreuter
Posted: 29 October 2009 18:25
How about PROMS/CROMS?

Patient-Reported Outcome Measures (PROMs)
Patient-reported outcome measures (PROMs) provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be completed by a patient or individual about themselves, or by others on their behalf.

The CROMS is for clinicians.
Title: OCM
Added by: John Mclennan
Posted: 28 October 2009 14:24
have you considered the Patient Global Impression of Change? There has been widespread use of the PGIC in recent chronic pain clinical trials (e.g. Dunkl et al., 2000; Farrar et al., 2001), and the data provide a responsive and readily interpretable measure of participants’ assessments of the clinical importance of their improvement or worsening. Impression of change scores using different verbal outcome categories have also been used to determine the minimally important changes in quality of life measures (e.g. Guyatt et al., 2002; Hagg et al., 2003). These measures appear to have validity.

Guy, 1976 W. Guy, ECDEU assessment manual for psychopharmacology (DHEW Publication No. ADM 76–338), US Government Printing Office, Washington, DC (1976).
Farrar et al., 2001 J.T. Farrar, J.P. Young, L. LaMoreaux, J.L. Werth and R.M. Poole, Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, Pain 94 (2001), pp. 149–158.
[sorry, don't have more refs]

Summary of current NICE OA guidance

noreply@blogspirit.com () — Wed, 28 Oct 2009 07:49:00 +0100

Click here for a useful diagram of these guidelines

Where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/Cox-2 inhibitor to paracetamol should be considered (other than etoricoxib 60 mg)

The National Collaborating Centre for Chronic Conditions. Osteoarthritis. National clinical guideline for care and management in adults. London: Royal College of Physicians, 2008.

Summary:

"The guideline contains a number of recommendations which are not currently routine practice for many clinicians. While the place of paracetamol in early pain management is confirmed, the guideline also suggests early consideration of topical non-steroidal anti-inflammatory drugs (NSAIDs) for knee and hand arthritis, and suggests that wherever systemic NSAIDs or cyclooxygenase-2 (COX-2) inhibitors are used, they should be coprescribed with cover from a proton pump inhibitor (PPI). This latter recommendation will surprise many, but with PPIs now coming off patent, it is clearly backed up by our health economic analysis. The positive role of exercise is emphasised in contrast to the natural inclination some might have to rest when a joint is affected by osteoarthritis. The GDG has also not shied away from negative recommendations. They suggest that arthroscopic lavage and debridement is not suitable therapy for osteoarthritis except in clear instances where this is associated with mechanical locking; and they do not recommend the use of intra-articular hyaluronans. Elsewhere, there is only restricted support for the use of acupuncture."

Interesting facts from this study:

"...there is no clear evidence so far that weight loss, either alone or in combination with exercise, can slow disease progression."

"There is evidence that TENS is clinically beneficial for pain relief and reduction of stiffness inknee osteoarthritis, especially in the short term. However, this was not shown in a community setting. There is no evidence that efficacy tails off over time, or that periodic use for exacerbations is helpful. Proper training for people with osteoarthritis in the placing of pads and selection of stimulation intensity could make a difference to the benefit they obtain. Good practice guidance recommends an assessment visit with the health professional with proper training in the selection of stimulation intensity (for example, low intensity, once a day, 40 minutes duration, 80Hz 140 microseconds pulse) with reinforcement with an instruction booklet. People with osteoarthritis should be encouraged to experiment with intensities and duration of application if the desired relief of symptoms is not initially achieved. This enables patients control of their symptoms as part of a self-management approach. A further follow-up visit is essential in allowing the health professional to check patients’ usage of TENS and problem solve."

"The results from acupuncture studies are mixed. Certainly the studies which have shown superiority of acupuncture over placebo have shown this only in the short term (6–12 weeks). At 26 weeks there are few studies, and overall they do not support a benefit over placebo. It
therefore seems likely that acupuncture can provide short- to medium-term relief for some people."

"Healthcare professionals should offer advice on appropriate footwear (including shock absorbing properties) as part of core treatment for people with lower limb osteoarthritis."

"The use of glucosamine or chondroitin products is not recommended for the treatment of osteoarthritis."

"Referral for arthroscopic lavage and debridement should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (not gelling, ‘giving way’ or x-ray evidence of loose bodies)."

"Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatment (see Fig 3.2); regular dosing may be required. Paracetamol and/or topical NSAIDs should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids."

"Topical capsaicin should be considered as an adjunct to core treatment for knee or hand osteoarthritis; rubefacients are not recommended for the treatment of osteoarthritis."

Upper limb disorders Occupational aspects of management

noreply@blogspirit.com () — Mon, 26 Oct 2009 16:29:10 +0100

Upper limb disorders Occupational aspects of management

This is a very up to date look at the evidence for the management of ULD's in the workplace. As with a lot of research, the only good evidence they have found is that multidisiplinary treatment with a biopsychosocial approach for non specific arm pain and changing a keyboard for carpal tunnel are better than usual care.

Occupational health course

noreply@blogspirit.com () — Fri, 23 Oct 2009 17:45:00 +0200

I attended an Occupational health course on 30 sept - 2nd Oct 2009 run by Nicoloa Hunter and Amanda Jones.

It was very informative. Things I learnt were:

1. Occupational epidemiology - statistics relating to occupational health and musculoskeletal disorders, i.e. Nurses have statistically more back pain than many other professions. In Lithuania whiplash does not exist as they have no compensation culture. NIOSH epidemiology of MSD's

2. Evidence based practice and LBP - there has been a republication of the NICE guidelines; non-specific low back pain that has lasted for more than 6 weeks, but for less than 12 months. Back in work for NHS employes is also a good guide and has soem great assessment tools. Functional restoration programmes are useful after 12/52 of LBP. The OREBRO questionnaire is a good outcome measure, scoring. The OREBRO (ÖMPQ) is a ‘yellow flag’ screening tool that predicts long-term disability and failure to return to work when completed four to 12 weeks following a soft tissue injury2. A cut-off score of 105 has been found to predict those who will recover (with 95 per cent accuracy), those who will have no further sick leave in the next six months (with 81 per cent accuracy), and those who will have long-term sick leave (with 67 per cent accuracy).

3. Evidence based practice and neck apin - there is no evidence for any clinical tests. Level 1 evidence for advising incresed movement and reassurance.

4. Confidentiality and consent - we must have the patient sign consent to discuss their problem with the occupational health dept. We can document this in our notes. The Disability Discrimination Act is important here.

Red Flags

noreply@blogspirit.com () — Thu, 15 Oct 2009 23:01:32 +0200

I was reading iCSP today and came across a debate about red flags. Something that came up was a "band of pain" across the abdomen and back as a red flag. See articles below:

Henschke, N., Maher, C. G. and Refshauge, K. M. (2007). "Screening for malignancy in low back pain patients: a systematic review." Eur Spine J 16(10): 1673-9.
Henschke, N., Maher, C. G. and Refshauge, K. M. (2008). "A systematic review identifies five "red flags" to screen for vertebral fracture in patients with low back pain." J Clin Epidemiol 61(2): 110-118.
Jarvik, J. G. and Deyo, R. A. (2002). "Diagnostic evaluation of low back pain with emphasis on imaging." Ann Intern Med 137(7): 586-97.
Mylona, E., Samarkos, M., Kakalou, E., Fanourgiakis, P. and Skoutelis, A. (2009). "Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics." Semin Arthritis Rheum 39(1): 10-17.

Ultrasound and fracture healing

noreply@blogspirit.com () — Mon, 14 Sep 2009 23:23:00 +0200

I was just looking into the evidence for ultrasound and fracture healing as I was debating whether or not to buy an Exogen bone healing ultrasound machine or known as a Sonic Accelerated Fracture Healing System (SAFHS).

The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis,

Busse, Bhandari, Kulkarni, Tunks, 2002.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=99352&blobtype=pdf

The pooled results showed that time to fracture healing was significantly shorter in the groups receiving low-intensity ultrasound therapy than in the control groups.

Low intensity ultrasound means levels of 30 mWcm2

Physio Charlie

STarT Back screening Tool

STarT back screening tool on the iCSP web

Outcome Measures

Summary of current NICE OA guidance

Upper limb disorders Occupational aspects of management

Occupational health course

Red Flags

Ultrasound and fracture healing

Low-intensity pulsed ultrasound: Fracture healing http://www.ijoonline.com/temp/IndianJOrthop432132-6330829_173508.pdf

Low-intensity pulsed ultrasound: Fracture healing
http://www.ijoonline.com/temp/IndianJOrthop432132-6330829_173508.pdf