Authors (including presenting author) :
Cheng KH William1, Cheung YM2, Cheung PCL1, KWONG WHS2, Yung W3, LI KK1, Leung AL2, Chan Andy3
Affiliation :
1Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital 2Ambulatory Care Clinic, Queen Elizabeth Hospital 3 Department of Physiotherapy, Queen Elizabeth Hospital
Introduction :
Back pain is a common problem attributing to demanding workload on Orthopaedic specialist clinics. Majority of patients have non-specific low back pain that do not need surgical or long-term orthopaedic intervention. Integrated Spinal Clinic (ISC) was established in 2019 to help this group of patients.
Objectives :
(1). Facilitate timely patient discharge and hence increase service capacity of Spinal Clinic. (2). To shorten duration of subsequent follow up in Spinal Clinic. (3). To shorten queuing time in Spinal Clinic. (4). To empower patients to manage their own back pain problem and regain control of their well-being. (5). To equip patients to shift from health-care system to a self-care model in community.
Methodology :
A study of 359 patients who attended ISC were recruited. Patients were initially assessed in a spinal clinic to exclude spinal pathology. They were then counselled and referred to a 6-month programme at ISC. Apart from 3 follow-up appointments, a self-help programme was provided by nurses and physiotherapists. The education included pain control strategies, exercises and life modifications. Active patient participation and partnership with health care professionals was emphasized. A satisfaction-survey was obtained before and after the programme. Patients were then discharged to community.
Result & Outcome :
359 patients (male 28%, mean age 61.2+/-12.4[27-92] years) were recruited from spinal clinic to ISC programme from 2019 to 2022. Patients had significantly lower pain score after completion of the programme (mean difference: Numeric Pain Rating Scale: -2.52, 95%CI: -2.23 to -2.80, and higher Numeric Global Rating of Change Scale: 4.12, 95%CI: 3.6 to 4.6). For patients whose back pain improved, there was a significant increase in the Hong Kong Short Form Healthy Survey (SF-12v2) physical component summary scores (mean difference: 2.47, 95%CI: 1.52-3.41) and mental component summary scores (mean difference: 2.36, 95%CI: 1.23-3.49) as compared to the baseline. 86% of patients were successfully discharged from the programme to community within 6 months. 14% of patients were referred back to spinal clinic for spinal management. The majority of patients adjusted well to the disease and no patients were referred to any clinics for similar issues after discharge from ISC. The Integrated Spinal Clinic has proven to be a success in addressing back pain without consuming additional resources. Patients have shown significant improvements in both their physical and mental status and this has helped facilitate them to successfully integrate back into the community. Most importantly, the establishment of ISC has helped to enhance service capacity for our current Spinal Clinic with subsequent follow up waiting time shortened from 104 to 92 weeks, and queuing time shortened from 120 to 58 minutes on day of follow up.
