Implementation of a Best Practice Primary Health Care Model for Low Back Pain

Numeric rating scale (NRS) for lower back related pain intensity during the latest week

Patient rated 11-point scale consisting of integers from 0 through 10; 0 representing ''No pain'' and 10 representing ''Worst imaginable pain''

Time frame: Baseline, 3, 6 and 12 months

Oswestry disability index (ODI) version 2.1

Patient rating of LBP disability analysed as a 0 to100 scale variable where lower scores represent lower levels of low back pain disability.

Time frame: Baseline, 3, 6 and 12 months

The European Quality of Life Questionnaire (EQ-5D)

Patient rating of health-related quality of life and is computed into a 0 to 1.00 scale from worst to best possible health state by using UK index tariffs.

Time frame: Baseline, 3, 6 and 12 months

The Brief Illness Perception Questionnaire (BIPQ)

Patient rating of cognitive illness representations (consequences, outcome expectancy, personal control, treatment control, and knowledge), emotional representations (concern and emotions) as well as illness comprehensibility. An overall score 0-80 represents the degree to which the LBP is perceived as threatening or benign where a higher score reflects a more threatening view of the illness

Time frame: Baseline, 3, 6 and 12 months

Patient Enablement Index (PEI)

Patient rating of enablement with a score range between 0 and 12 with a higher score intended to reflect higher patient self-care enablement

Time frame: 3, 6 and 12 months

Patient satisfaction

Patient rating of satisfaction asking "Over the course of treatment for this episode of low back pain or leg pain, how satisfied were you with the care provided by your health-care provider?" Were you very satisfied (1), somewhat satisfied (2), neither satisfied nor dissatisfied (3), somewhat dissatisfied (4), or very dissatisfied (5)?''

Time frame: 3, 6 and 12 months

Patient global rating of change (PGIC)

Patient rating of the degree of change in LBP related problems from the beginning of treatment to the present. This is measured with a balanced 11 point numerical scale.

Time frame: 3, 6 and 12 months

Practitioner Confidence Scale (PCS)

A total of 4 items are reported by the practitioner and a total score is collated where 4 represents greatest self-confidence and 20 represents lowest self-confidence

Time frame: Baseline, directly after commencement of implementation strategy and at 3 and 12 months afterwards

Clinician rated health care process measures

Grade of patient functional impairment and activity limitation according to the ICF brief core set for LBP is assesses by the physiotherapist where light, moderate, severe and very severe impairment/limitation is coded 0-4 respectively. A total score for baseline and an additional total score for follow-up measures at the final clinical contact (up to 3 months after baseline) is calculated from the sum of the functional impairments divided by the number of functional impairments and a similar total score is calculated for activity limitations. At the final clinical contact the therapists also report the ICD-10 diagnosis codes as well as type and number of patient treatment interventions.

Time frame: Baseline and final clinical contact (Up to 3 months where the time point is variable depending upon the amount of clinical contact required for each patient)

Pain Attitudes and Beliefs Scale for physical therapists (PABS-PT)

The PABS-PT consists of two factors where higher scores represent more treatment orientation regarding that factor, one measuring the biomedical treatment orientation (Score 0-60) and one regarding the biopsychosocial treatment orientation (Score 0-54)

Time frame: Baseline, directly after education and at 3 and 12 months afterwards