title: The role of clinical specialist physiotherapists in the management of low back pain in a spinal triage clinic.
abstract: BACKGROUND
  Traditional care pathways for patients with low back pain (LBP) where general practitioners (GPs) refer to consultant specialists can lead to excessive waiting times for patients and questionable use of health care resources. The evaluation of more cost effective pathways is a priority.
  
  
  OBJECTIVE
  The study aims to determine if clinical specialist physiotherapists can allocate patients into the three distinct diagnostic triage categories in line with international guidelines. A secondary aim is to examine the utility of baseline domains to inform clinical decision making.
  
  
  METHODS
  A review of LBP patients (n = 1,532) consecutively referred between 2008 and 2010 to a physiotherapy led spinal triage clinic was undertaken. Baseline demographics, pain severity (Visual Analogue Scale), disability (Roland Morris Disability Questionnaire), distress (Distress and Risk Assessment Method), mobility and function were assessed. Relationships between these factors were analysed.
  
  
  RESULTS
  Eighty-five percent of the population were deemed suitable for conservative management and were referred for either group exercise intervention (n = 1,125, 73 %) or individual treatment (n = 178, 12 %), in line with clinical guidelines. Fourteen percent were discharged and only 1 % required a specialist opinion. Patients allocated to the three management streams could be clearly discriminated by baseline measures of pain, distress, disability and function (p < 0.01).
  
  
  CONCLUSIONS
  Clinical Specialist physiotherapists are effective in assessing and selecting appropriate care pathways for LBP patients in line with international LBP clinical guidelines. The utility of the physical and psychological measures to differentiate between groups of varying clinical severity has important implications for treatment selection and management.
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland, susane.murph@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Murphy
authors.forename: C
authors.initials: C
authors.lastname: Blake
authors.forename: C K
authors.initials: CK
authors.lastname: Power
authors.forename: B M
authors.initials: BM
authors.lastname: Fullen
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D019091:Critical Pathways; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D059825:Physical Therapists; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D024382:Professional Role; D012189:Retrospective Studies; D016896:Treatment Outcome; D014218:Triage; D055815:Young Adult
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