Low Back PainTotal indicators and qualifiers: 26
Low back pain (LBP) is a common and costly condition.1, 2, 3 It is estimated that one in six Australians (approximately 3.7 million people, 13% of the population) experience LBP, and most (80% or 989, 483 people) report limitations in their daily activities.4 In Australia, the direct costs of LBP have been estimated at $4.8 billion.5 Several countries, such as the United Kingdom6 and USA,7 have produced clinical practice guidelines (CPGs) to help guide the management of LBP in primary care. Australian guidelines also exist although they are several years out of date.8, 9
Despite the availability of CPGs for the diagnosis and management of LBP, recent Australian surveys of people who self-manage their back pain10 and those managed by primary healthcare providers11 have revealed that care is often not evidence-based.1 In addition, our recent CareTrack Australia study demonstrated that, on average, people receive evidence-based care for LBP 72% of the time,12, 13 with particularly low compliance for documenting a thorough neurological examination, screening for serious diseases (such as infections), and inappropriate use of drugs (such as steroids) and treatments (such as traction).12 Therefore, the purpose of this wiki-based consultation process is to seek national agreement on what constitutes evidence-based and appropriate care for adults with LBP in Australia, and to organise this information within clinical indicators as a standard of care.
- Maher, C.G., Williams, C., Lin, C. and Latimer, J., 2011. Managing low back pain in primary care. Aust Prescr, 34(128), p.32.
- Walker B, Muller R, Grant W. Low back pain in Australian adults: the economic burden. Asia Pac J Public Health 2003;15:79-87.
- Walker B, Muller R, Grant W. Low back pain in Australian adults. Health provider utilization and care seeking. J Manipulative Physiol Ther 2004; 27:327-5.
- Australian Institute of Health and Welfare 2017. Back pain and problems. Available at: http://www.aihw.gov.au/back-problems/. Accessed: 8th March 2017.
- Arthritis and Osteoporosis Victoria & Deloitte Access Economics 2013, A problem worth solving: the rising cost of musculoskeletal conditions in Australia: a report, Elsternwick, [Victoria] Arthritis and Osteoporosis Victoria.
- National Institute for Health and Clinical Excellence. Early management of persistent non-specific low back pain. Quick reference guide. London: NICE; 2009.
- Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G. A., Shekelle, P., … Godges, J. J. (2012). Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 42(4), A1–57. http://doi.org/10.2519/jospt.2012.42.4.A1
- Acute low back pain. In: Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain. Brisbane: Australian Academic Press; 2003. p. 25-61.
- Rheumatology Expert Group. Therapeutic guidelines: rheumatology. Version 3. Melbourne: Therapeutic Guidelines Limited; 2017.
- Wilk V, Palmer HD, Stosic RG, McLachlan AJ. Evidence and practice in the self-management of low back pain: findings from an Australian internet-based survey. Clin J Pain 2010;26:533-40.
- Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, et al. Low back pain and best practice care: a survey of general practice physicians. Arch Intern Med 2010;170:271-7.
- Ramanathan, S.A., Hibbert, P.D., Maher, C.G., Day, R.O., Hindmarsh, D.M., Hooper, T.D., Hannaford, N.A. and Runciman, W.B., 2016. Care Track: Towards Appropriate Care for Low Back Pain. Spine.
- Runciman, W.B., Hunt, T.D., Hannaford, N.A., Hibbert, P.D., Westbrook, J.I., Coiera, E.W., Day, R.O., Hindmarsh, D.M., McGlynn, E.A. and Braithwaite, J., 2012. CareTrack: assessing the appropriateness of health care delivery in Australia. Medical Journal of Australia, 197(10), p.549.
Prof Chris Maher
Prof Chris Maher is a Professor in Sydney School of Public Health, The University of Sydney. He leads a research division focusing on the promotion of musculoskeletal health and physical activity across the lifespan. Prof Maher’s research evaluates the management of back pain and he has published 16 clinical trials in leading journals such as The New England Journal of Medicine (NEJM), The Lancet, and Annals of Internal Medicine (Ann Intern Med). He is an NHMRC Principal Research Fellow, Fellow of the Australian Academy of Health and Medical Sciences and a Fellow of the Australian College of Physiotherapy. He has over 500 publications, $43Million in research funding and 31 PhD completions. He is on the editorial board of the Cochrane Back and Neck group and Executive Committee for Australia and New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC). Prof Maher is an investigator on the Wiser Healthcare Collaboration.
Prof Peter O'sullivan
Peter is Professor at Curtin University, School of Physiotherapy and Exercise Science, Western Australia and works part time as a Specialist Musculoskeletal Physiotherapist at “Body Logic Physiotherapy”. He and his team conduct clinical research investigating the life course, underlying mechanisms and targeted management of persistent and disabling musculoskeletal pain disorders. With his team he has developed an integrated person centred management approach for disabling musculoskeletal pain disorders called ‘cognitive functional therapy’. He has published over 200 papers and numerous book chapters with his team in international peer review journals, has been an invited speaker at more than 90 National and International conferences and has run clinical workshops in over 24 countries. He has received research grants worth over $5million. Peter’s passion is translating research into clinical practice. He is active on social media (@PeteOSullivanPT) and has contributed to the development of web based resources for people in pain as well as health professionals (PAIN-ED and painHEALTH). His work has influenced the management of back pain internationally.
Dr Chris Needs
Dr Christopher Needs is a Staff Specialist Department of Rheumatology, Royal Prince Alfred Hospital (RPAH), Camperdown, NSW. He also works in a Private Rheumatology Practice in Kogarah. He has Masters Degrees in Medicine and Arts and is a Fellow of the Royal Australasian College of Physicians. He is the Co-Chair Musculoskeletal Network, NSW Agency of Clinical Innovation. He was the co-lead in developing the Model of Care for the treatment of acute low back pain. He supervises the Back Pain Clinic at RPAH and has helped implement the acute low back pain Model of Care in the Emergency department at RPAH. He was involved in the development of acute low back pain pathways in the Mid and NorthCoast online "Healthpathways". Current activities involve the release of a consumer version of the Low Back Pain Model of Care and developing an audit tool, in conjunction with the emergency department specialist interest physiotherapy group, to assess the management of low back pain in hospital emergency departments. Presentations on acute low back pain have been made at the Australian Rheumatology National meeting in 2015.
Dr Roya Dabestani
Roya graduated from Medical School in the UK in 2003. She worked in the NHS for 5 years before relocating to Australia in 2008. Roya became a member of the Royal College of General Practitioners in the UK in 2007, and the Royal Australian College of General Practitioners in 2008. She has special interests in chronic back pain, dermatology, mental health problems, and assisting patients with work related injury. Roya works as a Medical Advisor for the WorkSafe Clinical Panel involved with various back pain and return to work projects and also works in private practice.
Dr Kal Fried
Kal attained his Fellowship of the Australasian College of Sport & Exercise Medicince (ACSEP) in 1995 after a period in General Practice. In addition to consulting in this specialist field he has been a long term Medical Advisor with Worksafe and Transport Accident Commission (TAC) in Victoria. This role included activity on various higher level projects including reviewing clinical pathways in respect to high risk pharmacy and spinal surgery. He is also an Independent Medicolegal Examiner.
There have been several sporting team attachments over many years and during this period he also provided surgical assisting services mainly in the field of orthopaedics. Kal has developed interests in pain neurobiology and the practical clinical applications of this science as a basis for the biopsychosocial model of care, and also in terms of explaining harms and low value outcomes unintentionally arising from the standard management model. His other main interest is in ‘exercise as medicine’ in general, and specifically in its application to pain management.
In more recent times he has also developed an interest in educational techniques while presenting regularly on these topics and authoring a website with the aim of improving ‘pain literacy’. Academic contribution began recently via the following publication: Beales D, Fried K, Nicholas M, Blyth F, Finniss D, Moseley GL. Management of musculoskeletal pain in a compensable environment: Implementation of helpful and unhelpful Models of Care in supporting recovery and return to work. Best Pract Res Clin Rheumatol. 2016 Jun;30(3):445-467. (Abstract available here).
Prof Kieran Fallon
Kieran is currently Professor of Musculoskeletal, Sport and Exercise Medicine in the Faculty of Medicine at the Australian National University. His primary medical degree is from the University of Sydney and he holds Masters degrees in Higher Education and Sport and Exercise Science and is a Fellow of the Royal Australian College of General Practitioners and the Australasian College of Sport and Exercise Physicians (ACSEP). He holds an MD from the ANU on the topic of the Haematology and Biochemistry of the Elite Athlete. Kieran is a VMO in the Department of Rheumatology at The Canberra Hospital and was for 19 years at the Australian Institute of Sport, for 11 years as Head of the Department of Sports Medicine. Previous positions include two years in general practice, private sports medicine practice and CMO in Charge of Casualty, First Field Hospital, Australian Army. He has held academic positions at the University of Western Sydney, Edith Cowan University and currently is Adjunct Professor at the University of Canberra. He is Chair of the Research Committee of the ACSEP and a member of Medical Advisory Panel of St John Ambulance Australia. He has 50 publications in peer reviewed journals and has authored 15 book chapters. He maintains an interest in the limits of human performance and the role of exercise in the management and prevention of disease. His primary teaching focus involves all aspects of medicine as they relate to the musculoskeletal system, from first aiders to consultant level. Personal interests include medical mythbusting, teaching, playing guitar (badly), surfing, running, ballroom and latin dancing (reasonably), animal welfare and personal education in the areas of philosophy, economics, politics and Australian history.
Dr Malcolm Hogg
Dr. Malcolm Hogg is Head of Pain Services, Melbourne Health Clinical Associate Professor, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne. His contact details are: Department of Anaesthesia and Pain Management Royal Melbourne Hospital Parkville, VIC 3050 Ph: 03 9342 7540 Email: email@example.com Dr Hogg is also a Staff Specialist, Anaesthesia and Pain Management, at the Royal Melbourne Hospital and Head of Pain Services, Melbourne Health. Dr Hogg supervises a co-ordinated range of services, linking the acute and interventional pain services at the City Campus with persistent pain services at the Royal Park Campus. Therapies offered include interventional procedures for cancer and non-cancer pain, and allied health based pain management programs. Research interests include early identification and management of people with acute pain at risk of developing chronic disabling pain. Dr Hogg is the Immediate Past-President of the Australian Pain Society and current board member of "Painaustralia". He is co-ordinating the Waiting in Pain project, a systematic investigation into the provision of persistent pain services in Australia.
Dr Andrew Dwyer
Dr Andrew Dwyer, MBBS FRANZCR, is a diagnostic radiologist and fellow of the Royal Australian and New Zealand College of Radiologists with particular expertise in magnetic resonance imaging including its application in musculoskeletal medicine. He has received the University of Adelaide Award and Lister Medal along with the Frank S Hone, William Gardner and Linder Stamp prizes. In 2016 he was appointed as the RANZCR Bill Hare Fellow and sits on the college’s Clinical Research Committee. His relevant interests include the imaging of pars stress, the relationship of bone marrow signal on MRI to biomechanical loading and the management impact of dual energy CT in gout. He is currently the Clinical Director of the Clinical + Research Imaging Centre at the South Australian Health and Medical Research Institute (SAHMRI) in collaboration with Dr Jones & Partners Medical Imaging, a consultant radiologist at Flinders Medical Centre, and adjunct academic at Flinders University.
Prof Rachelle Buchbinder
Professor Rachelle Buchbinder MBBS (Hons), MSc, PhD, FRACP, FAHMS is an Australian NHMRC Senior Principal Research Fellow, rheumatologist and clinical epidemiologist. She is the Director of the Monash Department of Clinical Epidemiology, Cabrini Institute and Professor in the Department of Epidemiology and Preventive Medicine, Monash University. Current other roles include Joint Coordinating Editor of Cochrane Musculoskeletal, President of the Australian Rheumatology Association and founding member and Chair of the Executive Committee of ANZMUSC, the Australia and New Zealand Musculoskeletal Clinical Trial Network. She combines clinical practice with research in a wide range of projects relating to arthritis, other musculoskeletal conditions and health literacy. She has a longstanding commitment to knowledge synthesis and implementation of research evidence to guide clinical decision-making and improve patient outcomes. Her current program of work concerns reducing inappropriate or low-value care.
Prof Ian Harris
Ian Harris AM MBBS, MMed(Clin Epi), PhD, FRACS, FAHMS is Professor of Orthopaedic Surgery at UNSW Sydney. He is an active clinician specialising in trauma care and is Scientific Secretary for the Australian Orthopaedic Association (AOA). He is an academic with an interest in surgical outcomes. He has produced over 200 publications including systematic reviews, randomised trials, cohort studies and methodological studies. He has been awarded over $21 million in grant funding since 2012, including NHMRC Project, Partnership and Program grants as well as grants from government and not for profit organisations. He is Deputy Director of the AOA National Joint Replacement Registry, Co-chair of the Australia and New Zealand Hip Fracture Registry (ANZHFR), Director of the Arthroplasty Clinical Outcomes Registry National (ACORN), Chair of the Scientific Advisory Committee and Executive Member for the Australia and New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC) and holds positions in TORQUE, the NSW Trauma Outcomes Registry and within the Agency for Clinical Innovation (NSW). He is author of "Surgery, the Ultimate Placebo".
Prof Stephen Jan
Stephen Jan is Head of the Health Economics and Process Evaluation Program at the George Institute for Global Health and Conjoint Professor the University of New South Wales. He is an Honorary Professor at the University of Sydney, a Director of the Sax Institute, an Advisory Board member of the Deeble Institute and an Associate at both the Menzies Centre for Health Policy and the Poche Centre for Indigenous Health. He is a current NHMRC Principal Research Fellow and has previously held posts at the London School of Hygiene and Tropical Medicine and the Centre for Health Economics Research and Evaluation (CHERE) in Sydney. Stephen has over 20 years of experience in health economics, has published over 200 scientific articles and authored two textbooks in health economics. He has worked closely with various governments of different levels, both in Australia (Commonwealth and State) and overseas, with international agencies such as the WHO and industry. His areas of expertise are economic evaluation, health financing, health sector priority setting, Indigenous and global health issues and the economics of chronic disease.
A/Prof Helen Slater
Qualifications: PhD, FACP (Specialist Musculoskeletal Physiotherapist as awarded by the Australian College of Physiotherapists 2007), MAppSc (Phty), BAppSc(Phty) Helen is a clinical researcher and consultant physiotherapist at the School of Physiotherapy and Exercise Science, Curtin University. Helen’s interest lies with findings ways to get evidence about musculoskeletal pain into real world clinical settings. Along with colleagues, she researches Models of Care for people living with musculoskeletal pain; investigates how eHealth can support implementation of musculoskeletal Models of Care; explores musculoskeletal pain in young people; examines ways in which health policy can help lever best evidence into clinical practice; upskills consumers with pain and health professionals about pain; and investigates the ways in which the same clinical problem can present so differently in each individual (clinical phenotyping). Helen coordinates and lectures on clinical and pain units on the postgraduate Clinical Masters of Physiotherapy programs. She consults in private practice as a Fellow of the Australian College of Physiotherapists. Helen contributes to working groups on national and international pain-related professional societies. She currently co-chairs the International Association for the Study of Pain Physical Therapy curriculum review and sits on the Australian Digital Health Agency, Clinical and Technical Advisory Committee. Helen is also an Adjunct Professor at Notre Dame University, School of Medicine. See: http://oasisapps.curtin.edu.au/staff/profile/view/H.Slater
Prof Lorimer Moseley
Lorimer Moseley DSc PhD BPthy(Hons) FACP HonFPM(ANZCA) HonMAPAis a pain scientist and physiotherapist at the University of South Australia. He leads the Body in Mind research group, which investigates the role of the brain and mind in persistent pain. He has written 280 articles and six books, including Explain Pain (with David Butler) and Painful Yarns - the two highest selling pain books internationally. His papers have been downloaded 68,000 times on Researchgate alone and his research group’s outreach activities have been read or viewed by over 4 million people in 100 countries. He has given 65 plenary lectures at major international meetings in 26 countries, including the World European, American and British Pain Congresses. He won the inaugural Clinical Science Prize from the International Association for the Study of Pain, was runner-up in the 2012 Science Minister’s Prize for Life Sciences and won the 2012 Marshall & Warren Award from the NHMRC. His contributions to the field have been honoured by prizes or honours in 12 countries. He is an honoured member of the Australian Physiotherapy Association, its highest honour. Expertscape ranks him 1st in Australia for chronic pain and 2nd internationally for complex regional pain syndrome.
Prof Andrew Briggs
Andrew’s career has included senior roles in health policy and strategy, clinical practice and clinical and health services researcher. Currently, Andrew works as clinical physiotherapist in Melbourne and a health systems and services researcher at Curtin University in the area of musculoskeletal healthcare with a focus on health policy and translation of evidence into policy for musculoskeletal health. Andrew currently holds an NHMRC TRIP Fellowship and a Fellowship in Global Musculoskeletal Health from the Global Alliance for Musculoskeletal Health. In addition to clinical practice and research, Andrew works as a clinical advisor for WorkSafe Victoria, state governments and the World Health Organization. Andrew is recognised for his expertise in development and implementation of models of care for musculoskeletal healthcare and recently led the development of the Victorian osteoarthritis model of care. Andrew has also recently served on the guidelines development group for the Rheumatology 3 Therapeutic Guidelines and the RACGP Osteoarthritis Clinical Guidelines. Full profile available here: http://oasisapps.curtin.edu.au/staff/profile/view/A.Briggs.
Dr Ivan Lin
Dr Ivan Lin is a senior lecturer and NHMRC Early Career Research Fellow at the Western Australian Centre for Rural Health, University of Western Australia, physiotherapist with the Geraldton Regional Aboriginal Medical Service, and adjunct senior lecturer with the Curtin University School of Physiotherapy and Exercise Science. His interest is musculoskeletal pain; what mechanisms underlie musculoskeletal pain conditions and how healthcare for people with these conditions can be optimised. He primarily works in Aboriginal health care with a focus on implementing evidence into clinical care, the development of culturally appropriate health information, clinical communication, and reducing health care disparities. Further information about Dr Lin can be found at: http://www.wacrh.uwa.edu.au/2014-01-28-23-33-26/dr-ivan-lin
Dr Petrina Casey
Dr Petrina Casey is the Director, Insurance Policy & Design with principal responsibility for implementing the NSW Government’s 2015 Workers Compensation Benefit Reform Program. Petrina is a Registered General Nurse and holds a Master of Public Health and a Doctor of Philosophy from Sydney University Faculty of Medicine. As an author and co-author of many peer reviewed academic papers, her research has principally focused on the intersection between health, legal and claims outcomes in a personal injury compensation policy setting. Petrina has 25 years’ experience working in the personal injury insurance, disability and life insurance sectors in a range of senior strategic, policy and operational roles, with responsibility across strategy development, legislative reform and implementation, policy development, claims and injury management operations, scheme design, regulation and optimisation of insurance outcomes. Prior to joining SIRA, Petrina was a member of the Safe Work Australia Expert Work Health and Safety and Workers’ Compensation Panel and a member of the Deakin University Business School Personal Injury Advisory Board. She was also responsible for designing and delivering the curriculum for the Scheme Design, Strategic Claims Management and Contemporary Issues in Personal Injury Management Units as part of the Master of Management (Personal Injury) degree at Griffith and Deakin University Business Schools. She continues her involvement in teaching MBA students.
Prof Alex Collie
Alex Collie is Professor in the Faculty of Medicine Nursing and Health Sciences at Monash University, where he leads a research program at the intersection of insurance, work and health. Alex has established and led numerous large applied research projects in the fields of workplace health and injury compensation, within Australia and internationally. His current projects include a national comparative return to work project supported by nine Australian workers’ compensation regulators, and a major new program mapping work disability systems in Australia. Alex was previously CEO of the Institute for Safety, Compensation and Recovery Research (ISCRR) and Executive Director of the Victorian Neurotrauma Initiative (VNI). He is a Churchill Fellow, has a PhD in Psychology and is widely published. He lives in Melbourne with his wife and two children. You can follow Alex on twitter via @axcollie.
Ms Ornella Clavisi
Ornella Clavisi BSc (Hons), MPH Ornella Clavisi is the Chair of the Australia & New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC) consumer advisory group and is currently the Research and Knowledge Manager at MOVE muscle, bone & joint health (formerly Arthritis Victoria) a consumer organisation representing people with musculoskeletal conditions. In her role Ornella manages MOVE’s research program which funds researchers through project grants and scholarships as well as fostering consumer involvement in all aspects of research. She also has expertise in research methods, systematic reviews and evidence based practice and policy. She has previously worked for a number of organisation and institutes including the National Trauma Research Institute as program manager working on large scale knowledge translation trials in traumatic brain injury and managing an Evidence Service for the Victorian Transport Accident Commission and WorkSafe Victoria; Australian and New Zealand College of Anaesthetists (ANZCA) as the Research Manager of the ANZCA Trials Group; and the Monash Institute of Health Services Research developing evidence based reviews for the Medicare Benefits Advisory Committee and Pharmaceutical Benefits Advisory Committee.
Ms Debra Kay
Debra Kay (PSM) is a consumer, carer and consumer representative. She originally trained as a teacher and has undertaken health curriculum development, policy and research. This included development of policy, programs and services to support children with physical and mental health care needs to attend school and childcare without discrimination. She was acknowledged in the Australian Honors for this work. She has worked with The Smith Family; was CEO of Asthma Australia; and has developed a wide range of community health care training programs. Debra currently has a pro bono role as a Research Fellow in the Faculty of the South Australian Health and Medical Research Institute (SAHMRI) where she chairs the Consumer and Community Engagement Committee; has several government committee appointments including as Chair of the MBS (Medicare) Review Consumer Panel; is an NPS: Medicinewise Director; Chairs the Board of the Health Consumers Alliance of South Australia; and undertakes volunteer support and advocacy roles with a wide range of community organisations.