The feasibility and acceptability of the My Back My Plan program for management of acute low back pain in primary care

This is a prospective single cohort trial design study. This program for low back pain (LBP) is designed to be a low-cost and high-value personalised treatment option that can be delivered in primary care. This trial will test the feasibility and acceptability of the My Back My Plan (MBMP) program at primary care clinics at Macquarie University (MQ Health). The MBMP program involves interprofessional primary care for acute low back pain. Care will be personalised for each patient based on their clinical presentation and evaluated within a biopsychosocial framework. A combination of assessment findings using the Orebro Musculoskeletal Pain Questionnaire- short form (OMPSQ) score and clinician identified prognostic factors will be used to match the patient with the optimal MBMP Program level once the patient has enrolled into the study: MBMP Standard (includes up to 4 consultations over 2-3 weeks), MBMP Plus (includes up to 10 consultations over 6 weeks) and MBMP Intensive (includes more than 10 consultations and psychology treatment over 6-12 weeks). The MBMP program is an optimisation of usual care provided at MQ Health and as per usual care, a standard GP consultation is approximately 15 minutes and a standard physiotherapy consultation is approximately 60 minutes for an initial appointment and 30 to 45 minutes for subsequent appointments. The duration and frequency of the psychology treatment will be determined by the treating psychologist and may include face to face or online treatment options. Adherence to the delivery of the program principles will be gleaned from the clinicians and patient questionnaires developed for this study. Key principles of MBMP Program include: 1. Interdisciplinary patient care: All MBMP patients will have a GP and physiotherapist in their treatment team with a shared plan approach for communication of key information/education messages; psychological therapy may be added when indicated. 2. Early psychosocial evaluation: Relevant psychosocial factors will be evaluated for all patients in the initial assessments (GP and physiotherapist), by interview and screening questionnaire (OMPSQ). 3. A biopsychosocial understanding of LBP underpins patient care: Patient assessments will aim to identify key biological, psychological and social contributors to the patient’s back pain problem. 4. Person-centred treatment program: Clinicians and patient collaboratively develop a personalised treatment plan that addresses identified individual biopsychosocial contributors to their back pain. 5. Focus on self-management: Patients will be taught skills to help self-manage their back pain, prevent recurrences and manage flare-ups. 6. Early review times: Patients will be reviewed by GPs and physiotherapists within 2-3 days of initial consult. 7. Personalised and Stepped care: Optimal program selection will be guided by a protocol based on psychosocial screening (OMPSQ score) as well as clinician-identified factors that have established prognostic value. Care can be stepped up to MBMP Plus or MPMP Intensive for patients who require more interdisciplinary and/or intensive pain management. Patients will be encouraged to self-manage after 1-2 consultations with the GP (diagnosis, imaging, medications, advice) and 1-2 sessions with the physiotherapist (goal setting, exercise, education, self-management skills), facilitated with a Patient Booklet that has been designed for this program. Key elements of the MBMP program include: 1. My Back My Plan Patient Booklet: A booklet has been designed as a shared-care resource to facilitate communication between the patient and the health care team, and to support the patient to apply relevant aspects of their My Back My Plan program. 2. Collaborative goal-setting: Meaningful SMART goals will be established in collaboration with the patient, and will be listed in the My Back My Plan Booklet for all members of the health care team to review. 3. Tailored education: Person-centred education, tailored to each patient, regarding their diagnosis, prognosis and the nature of their back pain will be a cornerstone of the program and integrated throughout treatment. Where indicated by psychosocial assessment, education to address unhelpful thoughts and beliefs may be a significant component of treatment. Information in the My Back My Plan Booklet has been designed to support and tailor patient education. 4. Advice about returning to daily activities and work: Patients will be encouraged to gradually return to usual daily activities and work following appropriate rest. This advice will be carefully tailored to the physical requirements of each patient’s usual role and activity level. 5. Individualised physical activity program: Physical activity will be central to the MBMP program. The physiotherapist and GP will prescribe activities and exercises to improve function, reduce fear of movement / re-injury and achieve goals set in collaboration with the patient. Each patient’s physical activity program will be listed in the My Back My Plan Booklet, aided by photographs of exercises and a chart of individualised daily activities. 6. Analgesic medication advice: GPs will discuss the role of analgesic medication in the patients’ recovery plan, with dosing and time-frames established if medications are recommended. 7. Imaging advice: The role of imaging for managing back pain will be discussed with the patient, based on the principle that most patients with common back pain will not require imaging. The My Back My Plan Booklet is designed to help explain the limitations and potential harms of imaging.