Primary Care Focus On
Low Back Pain
Tools and education have been developed to assist you, as a primary care provider, in better managing your patients with low back pain. This work builds from the Ministry of Health and Long Term Care (MOHLTC) provincial initiative on Low Back Pain which aimed to enhance patient care, improve wait times and reduce inappropriate diagnostic utilization.
CORE BACK TOOL 2016
Developed in response to the needs identified by primary care providers (specific, but not limited to, Family Physicians and Nurse Practitioners) to integrate multiple existing tools and evidence into a comprehensive single tool for use in practice.
The Clinically Organized Relevant Exam (CORE) Back Tool will guide the clinician to recognize common mechanical back pain syndromes and screen for other conditions where management may include investigations, referral and specific medications. This is a focused examination for clinical decision-making in primary care. In 2016, Centre for Effective Practice updated the CORE Back Tool to reflect feedback from providers and recent evidence.
WHAT'S NEW WITH CORE BACK 2016?
- Addition of a cover page that provides some teaching pearls to support those using the CORE Back Tool for education and/or to support new users of the CORE Back Tool
- Integrated the identification of the mechanical patterns for low back pain into the history questions
- Revised the psychosocial Yellow Flags section into questions the provider can ask and hints on what to listen for making it easier to identify patients that are at higher risk for chronicity
- Integrated Patient Key Messages throughout the tool
- Included a NEW Management Matrix to offer suggestions for initial office management based on the patterns of low back pain
- The development of the new CORE Back Tool included an evidence review, expanded references and integration of expert input for areas where an approach was needed by primary care providers but where there is a lack of evidence
'IN THE KNOW' VIDEO
Watch our clinical lead Dr. Julia Alleyne speaking to the updated CORE Back Tool and how it can be used in practice.
SUPPORTING TOOLS
The following tools are aligned with the content in the CORE Back Tool and are provided for additional support when implementing the CORE Tool in your practice.
Opioid Risk Tool
| This tool identifies patients who may be at risk for opioid dependency so that appropriate medication management can be planned. |
Patient Education Inventory
| This tool is an inventory for primary care providers to help identify useful patient education material, including a brief description of the tool and identifying where it aligns with patient key messages consistent with the primary care provider curriculum and tools. |
Personal Action Planning for Patient Self Management
| This tool provides 3 key questions for effective goal setting with patients as well as a quick guide to engage patients in defining a self-management action plan. Available in colour or black and white |
The Keele STarT Back Screening Tool
|
This screening tool categorizes patients by risk of persistent symptoms (low, medium or high), which allows the clinician to tailor interventions appropriately. |
Where existing tools were used and/or modified for the CORE Back Tool, the developers and authors were contacted for permission. All supporting tools have been included in this toolkit with the permission of the developers and appropriate acknowledgement is indicated on each tool.
ONLINE EDUCATION
In the two years the online course was available over 5000 providers across Canada participated! CEP is exploring additional opportunities to allow for ongoing availability of the online course for providers in Canada. In the meantime, all course content is available to download as a PDF file below.
ADDITIONAL TOOLS
In addition to the above toolkit, the following reference tools are available for additional support:
For Providers
- Pharmacy Table: Acute and Subacute Low Back Pain - Pharmacological Alternatives5
- Pharmacy Table: Acute and Subacute Low Back Pain - Topical and Herbal Products6
- Evidence Summary for Management of Non-Specific Chronic Low Back Pain7
- Opioid Manager Switching Opioids Form8
For Patients
- Back Book9
- General Recommendations for Maintaining a Healthy Back10
- So Your Back Hurts11
- What You Should Know About Acute Pain12
- What You Should Know About Chronic Pain13
- Imaging Tests for Lower Back Pain: When You Need Them - And When You Don’t14
- Dr. Mike Evans Low Back Pain Patient Self-Management Video15 - watch the video below ↓
5-15full references available here.
LOW BACK PAIN PATIENT SELF-MANAGEMENT VIDEO
The Centre for Effective Practice is excited to release a new patient video on Low Back Pain created by Dr. Mike Evans (Health Design Lab) and developed in collaboration with the Government of Ontario, and the Institute for Work & Health.
The video is targeted at Ontario adults who may be experiencing an episode of low back pain and is based on existing primary care provider evidence-informed standardized clinical tools and resources previously developed as part of the provincial Strategy.
CLINICAL LEAD
Dr. Julia Alleyne
Clinical Lead
Dr. Julia Alleyne is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an associate clinical professor.
In 2009, she completed her Masters with a focus in Health Professions Education. Since that time, she has been active as an educational curriculum consultant including the clinical lead for Ontario’s Low Back Pain Strategy and program designer for the MSK Initiative in British Columbia. In 2013, she was appointed as the first Family Physician to be chair of Bone and Joint Canada
In addition, her work in the area of Back Care includes being an educational consultant for curriculum and tool development for provincial MSK initiatives in Ontario and British Columbia. She has co-authored a series of Spine related articles for Current Concepts in Care and is the co-chair for the Spine Quality Based Pathway. Dr. Alleyne has worked with the Centre for Effective Practice for a decade in the area of Primary Care Musculoskeletal tool development and education.