Collaborating with council services to encourage people with low back pain to self-manage in community settings

Purpose

Moving care out of hospital settings and into the community is a key focus of the NHS Five Year Forward View. We explored if it was feasible for NHS physiotherapists to deliver free back classes within local council leisure centres, and if they effectively helped to increase participant activity levels. A review of the back pain pathway within Wiltshire generated a desire to use a stratified approach to interventions. We chose to begin with those scoring low risk on the STarT back tool, aiming to deliver messages to foster a positive approach to exercise and prevent unhelpful beliefs developing. This service evaluation will inform the wider back pain pathway in Wiltshire and may provide insight to other physiotherapists planning similar projects.

95% of patients
felt more confident to manage their back pain

Approach

Managers, Physiotherapists and Council Active Health Coordinators collaborated to formulate a protocol. A one-off 90 minute class was designed which covered specific principles relating to back pain and self-management advice. Referral into the class was via a healthcare professional or self-referral. All participants filled in a STarT back tool prior to the class. Three pilot sites were chosen across Wiltshire.

During the class, a leisure instructor discussed exercise options with the group and participants were offered referrals for Active Health; a council scheme offering concessional leisure centre membership and personalised support. Data was collected on the number of referrals made and successful 12-week completion rates. Further qualitative data was collected regarding the classes themselves after the class and at six-weeks. Results are presented from two of the trial sites (South and West) over a 10 month period.

Outcomes

Of 65 class attendees, 50% signed up to Active Health and 80% either completed the 12 weeks or are more than half way through. Feedback from participants (n=47) showed that 92% agreed that the class helped them to understand their back pain and 95% agreed that they felt more confident to manage their back pain. Follow up at data at six weeks (n=24), revealed 71% reported they had increased their exercise levels and 67% reported making positive lifestyle changes.

Cost and savings

The council agreed to let us use the facilities at the leisure centre free of charge. The hand outs were not dissimilar to those used in our normal back class. The costs were purely through time given to set up the project. Increased efficiency was through saved new patient appointments at the hospital by those who self-referred straight into the class, also through saved follow up appointments and hopefully reduced re-referral rates because of both the information given during the session and also the ongoing support from Active Health with those who signed up to the programme. 

Implications

In the South and West of Wiltshire we demonstrated that it was feasible to run a back class within the local leisure centre, and a high percentage of attendees reported they had increased their activity levels. A randomised control trial might be useful to accurately compare physical activity outcomes to similar hospital based classes.

Frequency of classes was adjusted to reflect referral rates to ensure a minimum of five referrals per class. Class feasibility in the North of the county needs further investigation due to fluctuating attendance levels, possibly due to the lower population density. Self-referral numbers into the class was low in all regions; this could be improved through greater promotion and also via utilisation of first contact Physiotherapy practitioners in GP surgeries.

Offering a back class within a leisure centre opens opportunities for increasing access to physiotherapy, easing the pressure on hospital facilities and facilitating the transition from physiotherapy to self-management. The links built with council staff will offer opportunities for more collaborative working in the future.

Top three learning points

  1. That it was feasible to carry out a joint project with the council, including working within leisure centre settings.
  2. That people with low back pain generally opt for a 1:1 appointment before a class setting and therefore self-referral in to the class was low, but those who attended the class after a Physiotherapy assessment were very satisfied with the content.
  3. There seemed to be greater long term adherence rates to exercise as a result of the class held in the leisure centre, but future research would be useful to verify this.

Fund acknowledgements

This work was funded by Wiltshire Health and Care and Wiltshire Council.

Additional notes

This work was presented at Physiotherapy UK 2018.

The key project leaders were Carol Langley- Johnson, Clare Webb, Jo Marks and Claire Paling

The handbook given out in the class can be found on the website: http://wiltshirehealthandcare.nhs.uk/