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New approach could transform treatment of back pain in NZ

Thursday 13 June 2019 10:10pm

STarTBack-collage-image
Gail Sowden (Consultant Physiotherapist, Keele University) teaches and senior musculoskeletal physiotherapists from around New Zealand during the four-day STarT Back workshop at the Otago's School of Physiotherapy this week.

Lessons learned at a four-day training workshop hosted by Otago’s School of Physiotherapy this week may change the way back pain is treated in New Zealand.

Otago researchers, together with their colleagues at AUT in Auckland, have been working to develop the stratified care model for management of low back pain (STarT Back) in New Zealand. The model, which focuses on addressing psychosocial issues potentially relating to back pain, was originally developed in the UK.

"The potential for transformative change in how we manage back pain – particularly chronic, disabling back pain – is huge."

This week, thanks to support from Physiotherapy New Zealand and the Otago and Southland Physiotherapy Trust, Otago has hosted one of the UK trainers to teach a group of 19 experienced musculoskeletal physiotherapists from Otago, Southland, Canterbury and the greater Auckland region.

Bringing it to New Zeland is the result of over two years of collaborative work between Otago researchers and those from AUT.

Professor David Baxter from the University of Otago’s Centre for Health, Activity & Rehabilitation Research at the School of Physiotherapy says attending a workshop in the UK would cost up to $5,000 including flights, accommodation and course fees.

However, this week’s training has been free, and feedback has been overwhelmingly positive.

“The potential for transformative change in how we manage back pain – particularly chronic, disabling back pain – is huge. I undertook the training some three years ago (in the UK), and the impact on my research and practice has been significant.”

Back disorders are one of the leading causes of health problems in New Zealanders aged from 15 to 64. Between 2012 and 2013, $326.8 million was spent treating back pain with indirect costs from loss of income and productivity ballooning the figure to about $2.6 billion.

“It is recognised that psychosocial factors, such as patients’ beliefs that activity is harmful or a lack of support, are important predictors of poor outcomes for people with low back pain,” he says.

"It is recognised that psychosocial factors, such as patients’ beliefs that activity is harmful or a lack of support, are important predictors of poor outcomes for people with low back pain."

“STarT Back risk stratification represents a promising approach to better management of people with low back pain by matching treatment approaches to the presence or absence of psychosocial obstacles to recovery.”

STarT Back has been shown in the UK to improve patients’ phsycial function while reducing costs of care and is endorsed by the UK’s National Institute for Health and Care Excellence and NHS England, which provides funding for primary healthcare services in the UK.

Professor Baxter says the potential for implementation of this approach in New Zealand has been limited mainly because no clinically-practising physiotherapists have received the necessary training in psychologically-informed management required to manage the high-risk group of patients.

University of Otago and AUT staff involved in the project include Professor Baxter, Dr Lizhou Liu, Associate Professor Steve Tumilty, Drs Cathy Chapple and Ram Mani (University of Otago) as well as Professor Duncan Reid, Drs Richard Ellis and Julia Hill (AUT) together with Professor Tim Stokes from the University of Otago’s Department of General Practice and Rural Health.