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New Zealand Acute Low Back Pain Guide ll october 2004 edition

#1 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:13 PM

New Zealand Acute Low Back Pain Guide
INCORPORATING THE GUIDE TO ASSESSING PSYCHOSOCIAL YELLOW FLAGS IN ACUTE LOW BACK PAIN

ll october 2004 edition


http://www.acc.co.nz...t/wcm002131.pdf

october 2004 edition
Prepared by ll Endorsed by ll
ACC New Zealand Guidelines Group
P O Box 242, Wellington, New Zealand P O Box 10665, Wellington, New Zealand
Phone 0800 THINKSAFE (0800 844 657) Phone +64 4 471 4180
http://www.acc.co.nz Fax +64 4 471 4185
http://www.nzgg.org.nz
New Zealand Society of Physiotherapists
Royal New Zealand College of General Practitioners
New Zealand Register of Osteopaths

Acknowledgements
This guide was developed by an expert panel, convened by ACC, in wide consultation with New
Zealand professional groups. We acknowledge their valuable support and input, along with that of
the international experts who helped develop the Yellow Flags guide.
Expert panel
Juliet Ashton Consumers’ Representative, nominated by New Zealand Guidelines Group
Michael Butler Pain Specialist, and New Zealand Guidelines Group Representative
Margaret Bridge ACC Project Manager
Robin Griffiths Faculty and Society of Occupational Medicine (Chair 2001–2003)
James Hawtin Chiropractor
Nicholas Kendall Clinical Psychologist (Chair 2000–2001)
Christopher McGrath Osteopath
Harry McNaughton Rehabilitation Medicine Specialist
Susan Mercer Physiotherapist
David Nicholls Rheumatologist
Ross Nicholson Orthopaedic Surgeon
David Scott General Practitioner
James Watt Musculoskeletal Medicine Specialist
19

International team

Nicholas Kendall Formerly Senior Clinical Psychologist, Christchurch School of Medicine, in
collaboration with
Steve Linton Department of Occupational and Environmental Medicine, Orebro Medical
Centre, Sweden and
Chris Main Department of Behavioural Medicine, Hope Hospital, Salford; and
University of Manchester, UK

Contributing professional groups

New Zealand Society of Physiotherapists
School of Physiotherapy, University of Otago
School of Anatomy, University of Otago
New Zealand Manipulative Therapists’ Association
New Zealand Private Physiotherapists’ Association
New Zealand General Practitioners’ Association
Royal New Zealand College of General Practitioners
New Zealand Chiropractors’ Association
Australasian Faculty of Rehabilitation Medicine
New Zealand Pain Society
New Zealand Register of Acupuncturists
New Zealand Register of Osteopaths
New Zealand Association of Musculoskeletal Medicine
New Zealand Orthopaedic Association
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#2 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:19 PM

http://www.acc.co.nz...t/wcm002131.pdf

Acute Low Back Pain Screening Questionnaire
linton & halldén, 1996)

Today’s date ll / / ACC Claim Number ll
Name ll
Address ll
Telephone ll home ( ) ll work ( )
Job Title ll occupation Date stopped work this episode ll / /
These questions and statements apply if you have aches or pains, such as back, shoulder or neck pain. Please read and answer each
question carefully. Do not take too long to answer the questions. However, it is important that you answer every question.

There is always a response for your particular situation.
1. What year were you born?
2. Are you male female
3. Were you born in New Zealand? yes no
4. Where do you have pain? Place a ✓ for all the appropriate sites.
neck shoulders upper back lower back leg
2x count
5. How many days of work have you missed because of pain during the past 18 months? Tick (✓) one.
0 days [1] 1-2 days [2] 3-7 days [3] 8-14 days [4] 15-30 days [5]
1 month [6] 2 months [7] 3-6 months [8] 6-12 months [9] over 1 year [10]
6. How long have you had your current pain problem? Tick (✓) one.
0 days [1] 1-2 days [2] 3-7 days [3] 8-14 days [4] 15-30 days [5]
1 month [6] 2 months [7] 3-6 months [8] 6-12 months [9] over 1 year [10]
7. Is your work heavy or monotonous? Circle the best alternative.
1 2 3 4 5 6 7 8 9 10
< Not at all Extremely >
8. How would you rate the pain that you have had during the past week? Circle one.
1 2 3 4 5 6 7 8 9 10
< No pain Pain as bad as it could be >
9. In the past 3 months, on average, how bad was your pain? Circle one.
1 2 3 4 5 6 7 8 9 10
< No pain Pain as bad as it could be >
10. How often would you say that you have experienced pain episodes, on average, during the past 3 months?
Circle one.
1 2 3 4 5 6 7 8 9 10
< Never Always >
11. Based on all the things you do to cope, or deal with your pain, on an average day, how much are you able to
decrease it? Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t decrease Can decrease it completely >10 – x

12. How tense or anxious have you felt in the past week? Circle one.
1 2 3 4 5 6 7 8 9 10
< Absolutely calm and relaxed As tense as I’ve ever felt >
13. How much have you been bothered by feeling depressed in the past week? Circle one.
1 2 3 4 5 6 7 8 9 10
< Not at all Extremely >
14. In your view, how large is the risk that your current pain may become persistent? Circle one.
1 2 3 4 5 6 7 8 9 10
< No risk Very large risk >
15. In your estimation, what are the chances that you will be working in 6 months? Circle one.
1 2 3 4 5 6 7 8 9 10
< No chance Very large chance >
10 – x
16. If you take into consideration your work routines, management, salary, promotion possibilities and work mates,
how satisfi ed are you with your job? Circle one.
1 2 3 4 5 6 7 8 9 10
< Not at all satisfi ed Completely satisfi ed >
10 – x
Here are some of the things which other people have told us about their back pain. For each statement please circle one number from
0 to 10 to say how much physical activities, such as bending, lifting, walking or driving would affect your back.
17. Physical activities make my pain worse. Circle one.
1 2 3 4 5 6 7 8 9 10
< Completely disagree Completely agree >
18. An increase in pain is an indication that I should stop what I am doing until the pain decreases. Circle one.
1 2 3 4 5 6 7 8 9 10
< Completely disagree Completely agree >
19. I should not do my normal work with my present pain. Circle one.
1 2 3 4 5 6 7 8 9 10
< Completely disagree Completely agree >
Here is a list of fi ve activities. please circle the one number that best describes your current ability to participate in each of these
activities.
20. I can do light work for an hour. Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t do it because of pain problem Can do it without pain being a problem >
10 – x
21. I can walk for an hour. Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t do it because of pain problem Can do it without pain being a problem >
10 – x
22. I can do ordinary household chores. Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t do it because of pain problem Can do it without pain being a problem >
10 – x
23. I can go shopping. Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t do it because of pain problem Can do it without pain being a problem >
10 – x
24. I can sleep at night. Circle one.
1 2 3 4 5 6 7 8 9 10
< Can’t do it because of pain problem Can do it without pain being a problem >
10 – x
sum
ACC1631 • Oct 2004
38

table 1: acute low back pain screening questionnaire –
to predict risk of long-term work loss (linton & halldén, 1996)
Pads of Questionnaires are available from the provider order line 0800 802 444
scoring instructions – acute pain screening questionnaire
ll For question 4, count the number of pain sites and multiply by 2
ll For questions 6, 7, 8, 9, 10, 12, 13, 14, 17, 18 and 19 the score is the number that has been
ticked or circled
ll For questions 11, 15, 16, 20, 21, 22, 23 and 24 the score is 10 minus the number that has
been ticked or circled
ll Write the score in the shaded box beside each item – questions 4 to 24
ll Add them up, and write the sum in the box provided – this is the total score
Note: the scoring method is built into the questionnaire
interpretation of scores – acute pain screening questionnaire
questionnaire scores greater than 105 indicate that the patient
is at risk.
This score produces:
ll 75% correct identifi cation of those not needing modifi cation to ongoing management
ll 86% correct identifi cation of those who will have between 1 and 30 days off work
ll 83% correct identifi cation of those who will have more than 30 days off work
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#3 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:23 PM

http://www.acc.co.nz...t/wcm002131.pdf

table 3: advantages of questionnaires
ll Quick to administer
ll Useful for screening large numbers
ll Little skill needed
ll Interpretation is usually unequivocal
ll Can be statistically based on evidence

disadvantages of questionnaires

ll Require time to score, need to check for missing information
ll Unsuitable for those with reading problems
ll May not be applicable to all members of a community, eg, new immigrants
ll May only predict one goal, eg, work loss but not pain
ll May be too sensitive to time of measurement
ll Susceptible to confounding factors, such as social desirability, or ‘impression
management’ such as the person telling you what they think you want to hear

continued… 53

table 3: continued
advantages of clinical assessments
ll Clinician can adapt readily to characteristics of the individual
ll Incorporates clinical experience
ll Facilitates establishing potential goals for intervention
ll Less susceptible to confounding factors, such as social desirability or ‘impression
management’
ll Judgements about severity can be made

disadvantages of clinical assessments
ll Potentially time consuming
ll May result in confused picture unless clinical skill level is adequate
ll Possibility of observer bias or prejudice

advantages of combinations of questionnaires with
clinical assessments

ll Improved accuracy
ll Clinician can integrate quantitative information with clinical data
ll Can use two stage process with questionnaire as fi rst stage fi lter to target clinical
assessments

disadvantages of combinations of questionnaires with
clinical assessments

ll Require more resources, including the need for adequate organisation and training
ll More time needed, potential for delays
54
ll
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#4 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:27 PM

It is observed in this section on page #60 that there is no reference whatsoever to those whom actually have the spinal/back injuries for their opinion & feedback.
Why not?
They are the ones most effected and live with the injury.


http://www.acc.co.nz...t/wcm002131.pdf

The Expert Panel advised on an implementation strategy and has also undertaken to regularly review
and update the document.


However, international research indicates that evidence based guidelines alone will not encourage
treatment providers to adopt best clinical practice.


The implementation strategy therefore involves:
ll Educational forums that include local treatment providers and at least one member of the Expert
Panel.
ll Educational strategies for ACC medical advisors and case managers.
ll Surveys of treatment providers.
ll Regular reminders to treatment providers about the guidelines.
The Panel noted there is an opportunity for health professionals to broaden their skills in the
management of acute and recurrent low back pain.
There is also a need for further research on many related issues.
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#5 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:35 PM

http://www.acc.co.nz...t/wcm002131.pdf

A Brief History of Back Pain Task Forces and Guidelines
1987: The Quebec Task Force on Spinal Disorders (QTFSD), Canada
ll Emphasised the magnitude of the problem.
ll Identified a lack of consistent classification or diagnoses.
ll Psychosocial issues were considered secondary reactions, not relevant to early
management.

1993: WorkCover, South Australia

ll Made an attempt to simplify classification with a new proposal that the classifi cation
of “back strain” should only be allowed for a maximum of eight weeks.
ll Provided a description of usual clinical practice. Did not attempt to provide critical
reasoning or analysis.
ll Appended a psychosocial assessment, with an untested scale to indicate the risk of
work loss.

continued
1994: Agency for Health Care Policy and Research (AHCPR), USA
ll Performed an extensive literature review using an “Expert Panel” methodology.
ll Reviewed the scientifi c evidence based on operational criteria. Made
recommendations on the basis of this evidence.
ll Psychosocial issues were acknowledged and emphasised, but not well articulated.

1994: Clinical Standards Advisory Group (CSAG), UK
ll Made strong statements about the magnitude of the problem and the economic
costs.
ll Made recommendations based on the AHCPR literature review.
ll Acknowledged psychosocial issues and recommended the adoption of a
biopsychosocial model.
ll Recommended a comprehensive (biopsychosocial) assessment at six weeks.

1995: Pain in the Workplace Task Force (PIW),
International Association for the Study of Pain (IASP)

ll Emphasised a new category called “non-specific LBP”.
ll Made controversial recommendations for purchasers and compensation systems,
including stopping payment for treatment and transferring to unemployment status at
seven weeks.


1995: Quebec Task Force on Whiplash Associated Disorders
(QTWAD), Canada

ll Emphasised classification followed by management plans.
ll Recommended a mandatory comprehensive assessment at either six or 12 weeks
depending on the severity classification.
ll This mandatory multidisciplinary assessment was to include musculoskeletal and
psychosocial expertise.


continued
1996: Accident Rehabilitation, Compensation and Insurance
Corporation (ACC) and National Health Committee (NHC), NZ

ll The AHCPR guidelines were distributed at the “Spine in Action” Conference, January
1996.
ll Post-conference seminars emphasised the prevention of chronicity.
ll Feedback resulted in the formation of a task force to develop a New Zealand version
of the guides that addressed psychosocial factors.


1996: Royal College of General Practitioners (RCGP), UK

ll Produced a revised edition of the CSAG guidelines.
ll Made strong recommendations that patients should be encouraged to return to usual
activities.
ll Recognised that at the highest level of evidence, psychosocial factors are important
in chronic low back pain and disability.
ll Recognised that psychosocial factors are more important at the early stages than
previously considered.

1997: Accident Rehabilitation, Compensation and Insurance
Corporation (ACC) and National Health Committee (NHC), NZ

ll Published the New Zealand Acute Low Back Pain Guide.
ll Published the Guide to Assessing Psychosocial Yellow Flags.

1999: Royal College of General Practitioners (RCGP), UK
ll Produced an updated version of the UK guide that included two new principal
recommendations:
l The optimum timing for using manipulation is unclear.
l Adopted the New Zealand-developed concept of Psychosocial Yellow Flags
(Kendall, Linton & Main, 1997).

continued
1999:Updated version of the New Zealand Acute Low Back Pain Guide
(NHC and ACC)

ll New Zealand Acute Low Back Pain Guide review, April 1999.
ll Published update of the 1997 Guide.

Updated version of the New Zealand Acute Low Back Pain Guide
(New Zealand Guidelines Group and ACC).

ll New Zealand Acute Low Back Pain Guide review, 2002.
ll The publication was updated and incorporated the Guide to Assessing Psychosocial
Yellow Flags in Acute Low Back Pain

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