Welcome back to Spine IQ’s Back Blog! In June we reviewed strategies to help clinicians include exercise as a treatment option for patients with low back and neck pain. For the month of July, we will focus on the use of evidence-based screening tools and outcomes questionnaires in the spine care setting. This week we tackle the important ‘why’, followed in weeks 2-4 by the equally important ‘how’ regarding implementation of these important measures into your practice.
What is a screening tool?
A screening tool is a questionnaire that can be used by spine care clinicians to identify patient-level factors that may be able to predict a patient’s prognosis. This is important for several reasons. First, screening tools allow early detection of patients who are at higher risk of unfavorable outcomes and/or have an increased chance of transitioning from acute to chronic low back pain. Such information can help guide decisions regarding whether to involve other healthcare professionals in the care of the patient. (2) Second, current evidence-based clinical guidelines (1) suggest that the use of screening tools can help to inform both patients and clinicians about the patients expected prognosis, which may impact decisions on how much care is given. Third, screening tools provide information that allows you to have a more informed conversation with your patient about what treatments might be most effective and how your care may be required. This is important, especially since today’s care is increasingly moving from a paternalistic (doctor knows best) model to a shared decision making model that takes patient preferences into consideration. Finally, knowledge regarding the potential for an unfavorable outcome early in the care and management of a patient can serve as a warning to be on alert for future issues that may increase your risk as a clinician.
What is a patient-reported outcome measures (PROMs)?
PROMs are evidence-based questionnaires completed by the patient that can be used in spine care to help evaluate and monitor pain or other clinically relevant outcomes. Clinical practice guidelines recommend that clinicians use PROMs for patients with low back pain. (1) It’s important that clinicians choose PROMs that are evidence-based and clinically relevant to the patient they are treating. (3) These questionnaires, which are available and easy to incorporate into any practice, can provide essential documentation regarding the outcomes of care provided to your patient. These measures also provide the clinician and staff with confidence that patient care is properly managed and monitored. Additionally, outcome measures can help open conversations with patients about their pain experience.
Stay tuned for next week’s blog to learn how to incorporate and interpret these tools in your clinic!
References:
- National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management [Internet]. London: National Institute for Health and Care Excellence (UK); 2016 [cited 2021 Jun 11]. (National Institute for Health and Care Excellence: Clinical Guidelines). Available from: http://www.ncbi.nlm.nih.gov/books/NBK401577/
- Khan Y, Lawrence D, Vining R, Derby D. Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey. Chiropr Man Ther [Internet]. 2019 Jan 15 [cited 2021 Mar 27];27. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332914/
- Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, et al. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1–57.