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Sugavanam T1, Williamson E1, Ali U1, Richmond H1, Hansen Z1, Fordham B1, Lamb SE1
1University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
Background: The Back Skills Training (BeST) programme is a group Cognitive Behavioural Approach for people with persistent (≥6 weeks) low back pain (LBP). The programme was shown to be clinically and cost-effective in a large clinical trial. To facilitate implementation of the BeST programme, an online training programme was developed.
Purpose: To evaluate the implementation of the BeST programme within the National Health Service (NHS) in the United Kingdom (UK).
Methods: We conducted a pre-post cohort study design between March 2016 and July 2018. Health Professionals were trained to deliver the BeST programme via the online training and then delivered the BeST programme within their NHS departments. Patients with LBP were eligible for the service evaluation if they were aged 18 years and over, provided contact details to the study team and were deemed suitable for the BeST programme by treating staff. Patients attend for an individual session (60 minutes) followed by 6 group sessions of 90 minutes which equip patients with the skills to self-manage their LBP. We measured pain (Numerical Rating Scale) and function (Pain Specific Functional Scale) at baseline, group completion and at 3 months and 12 months follow up. We measured Global Perceived Effect at each follow up point. Satisfaction with the programme (Client Satisfaction Questionnaire) was measured.
Results: 133 groups were delivered to 758 patients at 36 NHS departments with a mean group size of six (SD 1.8, range 1-12). Missing data was an issue as data was collected by busy clinical staff. Of the available demographic data (n=389), there were 279 females (71.7%) and 110 males (28.3%) with a mean age of 55.3 (SD 11.5) years. Patients, on average, had back pain for 13 (SD 9.9) years. Of the 641 patients with attendance data, 514 (80%) participants attended three or more sessions. Patients showed a statistically significant improvement in pain (p 0.001) and function (p 0.001) at all 3 follow up points compared to baseline (paired t-tests). Further analysis using repeated measures ANOVA, for patients with data at all time points, demonstrated a similar statistically significant effect for pain (n=153, F(3, 456) = 14.852, p 0.001) and function (n=133, F(3, 396) = 44.919, p 0.001). Of 516 participants, 391 (75.8%) reported improvement on group completion with 60.1% (n=243/405) and 51.4% (n=129/251) reporting improvement at 3 months and 12 months respectively. More than 80% of the participants reported that they were satisfied with the programme.
Conclusion(s): The implementation of the BeST Programme into NHS care resulted in improvements in pain and function and the majority of patients were satisfied with the programme. The BeST programme can be used to deliver clinically and cost -effective evidence-based treatment to patients with LBP.
Implications: We demonstrate that the effects observed in clinical trials could be replicated in routine clinical practice after web-based training. The next step is to make the BeST programme available to the global physiotherapy community. The online training will be made available to all health professionals managing patients with LBP in 2019.
Keywords: Implementation, Low Back Pain, Cognitive Behavioural Approach
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Purpose: To evaluate the implementation of the BeST programme within the National Health Service (NHS) in the United Kingdom (UK).
Methods: We conducted a pre-post cohort study design between March 2016 and July 2018. Health Professionals were trained to deliver the BeST programme via the online training and then delivered the BeST programme within their NHS departments. Patients with LBP were eligible for the service evaluation if they were aged 18 years and over, provided contact details to the study team and were deemed suitable for the BeST programme by treating staff. Patients attend for an individual session (60 minutes) followed by 6 group sessions of 90 minutes which equip patients with the skills to self-manage their LBP. We measured pain (Numerical Rating Scale) and function (Pain Specific Functional Scale) at baseline, group completion and at 3 months and 12 months follow up. We measured Global Perceived Effect at each follow up point. Satisfaction with the programme (Client Satisfaction Questionnaire) was measured.
Results: 133 groups were delivered to 758 patients at 36 NHS departments with a mean group size of six (SD 1.8, range 1-12). Missing data was an issue as data was collected by busy clinical staff. Of the available demographic data (n=389), there were 279 females (71.7%) and 110 males (28.3%) with a mean age of 55.3 (SD 11.5) years. Patients, on average, had back pain for 13 (SD 9.9) years. Of the 641 patients with attendance data, 514 (80%) participants attended three or more sessions. Patients showed a statistically significant improvement in pain (p 0.001) and function (p 0.001) at all 3 follow up points compared to baseline (paired t-tests). Further analysis using repeated measures ANOVA, for patients with data at all time points, demonstrated a similar statistically significant effect for pain (n=153, F(3, 456) = 14.852, p 0.001) and function (n=133, F(3, 396) = 44.919, p 0.001). Of 516 participants, 391 (75.8%) reported improvement on group completion with 60.1% (n=243/405) and 51.4% (n=129/251) reporting improvement at 3 months and 12 months respectively. More than 80% of the participants reported that they were satisfied with the programme.
Conclusion(s): The implementation of the BeST Programme into NHS care resulted in improvements in pain and function and the majority of patients were satisfied with the programme. The BeST programme can be used to deliver clinically and cost -effective evidence-based treatment to patients with LBP.
Implications: We demonstrate that the effects observed in clinical trials could be replicated in routine clinical practice after web-based training. The next step is to make the BeST programme available to the global physiotherapy community. The online training will be made available to all health professionals managing patients with LBP in 2019.
Keywords: Implementation, Low Back Pain, Cognitive Behavioural Approach
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Topic: Disability & rehabilitation; Pain & pain management; Musculoskeletal: spine
Ethics approval required: No
Institution: University of Oxford
Ethics committee: Clinical Trials and Research Governance (CTRG)
Reason not required: This was service evaluation of routine care and not research study. Audit department at each participating hospital provided local approval.
All authors, affiliations and abstracts have been published as submitted.
