Biopsychosocial evaluation of a spinal triage service delivered by physiotherapists in collaboration with orthopaedic surgeons

Background: Low back pain (LBP) and low back related disorders are highly prevalent and associated with a considerable burden of pain, disability and work loss. People with a variety of low back-related complaints comprise a large proportion of referrals made to orthopedic surgeons and many of these patients are not considered to be surgical candidates or have not maximized their non-surgical options for managing their low back-related complaints. Objectives: We sought to evaluate the impact of a triage assessment program delivered by physiotherapists using a variety of approaches. Informed by a biopsychosocial model, the objectives of this dissertation were: 1) To determine the short term impact of a physiotherapy triage assessment for people with low back-related disorders on participant self-reported pain, function and quality of life and patient and referring practitioner satisfaction. 2) To determine which demographic, clinical, psychosocial and environmental factors are predictive of improved self-reported pain, function, quality of life and participant and referring practitioner satisfaction. 3) To determine the diagnostic and treatment recommendation concordance between physiotherapists and orthopaedic surgeons, using a newly developed clinical classification tool, for people presenting to a spinal triage assessment service with low back complaints. Methods: Two approaches were used to achieve the aforementioned objectives: a prospective observational study (n=115) to address the first two objectives and a sub-group reliability study (n=45) to address the third objective. Results: There was a mean overall significant improvement in the SF-36 Physical Component Summary at the 4-6 week post-test time point and relatively high satisfaction reported by participants and referring care providers. Qualitative analysis of comments revealed a variety of positive, negative and other contextual factors that may impact outcomes. A variety of different sociodemographic, psychological, clinical and other variables were associated with success or improvement in each respective outcome. There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress were more likely to improve on certain outcomes. There was high diagnostic concordance between physiotherapists and an orthopaedic surgeon; however, there were more differences in management recommendations between the surgeon and a solo physiotherapist versus physiotherapists working in a collaborative team. Conclusions: A spinal triage assessment program delivered by physiotherapists has the potential to positively impact a variety of patient-related short term outcomes including satisfaction. Further study is needed to examine longer-term outcomes and which biopsychosocial factors may impact these outcomes