Care pathway for chronic lower back pain

The increasing incidence of chronic diseases like chronic lower back pain and the ageing population have significant implications for the sustainability and efficiency of healthcare systems worldwide. Chronic lower back pain has a major impact on your daily functioning. Almost all back pain is caused by conditions that can be improved by a thorough treatment programme and proper guidance.

That is why, at Maria Middelares General Hospital, we organise the Chronic Lower Back Pain Care Programme. This is a multidisciplinary programme based on the principles of value-driven care. The goal of our multidisciplinary team is to help/support you in achieving the highest possible level of functioning and quality of life.

For most people, a conservative approach is the most appropriate option. This often includes a combination of stretching exercises, trunk stability training, fitness building, psychoeducation, lifestyle and self-management classes, medication and infiltrations.

If necessary, surgery may be recommended for a small minority and may also be part of the care pathway.

For whom?

The pathway targets patients who have been suffering from lower back pain for more than three months and have not yet undergone surgery for this.

Origin

The Chronic Lower Back Pain Care Pathway emerged from the multidisciplinary collaboration within our SpineUnit. It is based on the Federal Health Care Knowledge Centre guidelines and is developed according to the rigorous standards of the Value-Based Health Care (VBHC) concept or value-driven care.

Patients sometimes think that moving around a lot will make their pain worse, when it is actually just the opposite.

Value-driven care:

The ultimate goal of any health system is to keep a population functioning in good health and to improve people’s longevity and quality of life. What constitutes valuable care varies from patient to patient. Therefore, we approach each individual individually and work with the principles of value-driven care.

‘We place the patient at the centre of our care’

Value-driven care means that patient care is organised based on the patient 's own needs and preferences. This is precisely why care is organised around the individual patient. This places the patient truly at the centre. Determining how we add value or what is valuable is accomplished via conversations between the patient and care provider. The aim is to improve patient outcomes while keeping health-care costs manageable.

Multidisciplinary

The multidisciplinary team includes doctors/staff from the physical rehabilitation, pain centre and back surgery services, the back coach, physiotherapy, occupational therapy, psychology and the Social Services.

Back coaches

The back coaches are the central registration point. They open the file, perform the (telephone) intake and, in close consultation with the multidisciplinary team, initiate the care pathway. They will also continue to closely monitor the patient.

Practical aspects

After referral by your GP or specialist , you register with our Back Coach, who will conduct an intake interview (by phone) with you. The Back Coach will ask you to complete some (online) questionnaires . On this basis, your file will be prepared and a 'carousel' of appointments will be booked to assess your symptoms and your level of functioning.

The ‘carousel’ of appointments will be held on the same day. You will have an appointment with the algologist (pain doctor), rehabilitation doctor, physiotherapist and the occupational therapist. Depending on your needs, an appointment may also be made with Social Services, a psychologist and/or a back surgeon.

The ‘carousel’ is followed by a multidisciplinary consultation between all care professionals involved, who will formulate a joint recommendation. Immediately after this consultation, you will have an opportunity to discuss your results and treatment options.

Depending on the advice formulated, the follow-up of your back problems can be done externally or in our hospital. Thus, you can — if necessary — follow a comprehensive back rehabilitation programme at our hospital, whether or not combined with treatment at the pain centre. If necessary, a referral can always be made to the back surgeon.