Abstract
Objectives
Back pain is one of the most common causes of disability in the UK. Management guidelines for the treatment of acute back pain have been published. Auditing patients’ physiotherapy treatment records is one way of monitoring standards of care. Standards were developed using published evidence-based treatment, self-management guidelines and local standards within a physiotherapy outpatient department.
Design
Physiotherapy treatment notes for patients referred with low back pain were audited in 1996 (Audit 1). The audit was repeated in 2001 (Audit 2) after additional standards were implemented following the results of Audit 1.
Setting
Physiotherapy Outpatient Department, Addenbrooke's NHS Trust Hospital, Cambridge, UK.
Results
In Audit 1, 66% and 88% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Sixty-four percent of patients were advised to keep active, 96% showed evidence of diagnostic triage, 65% showed evidence of mobilisation, none were recommended bed rest (100% compliance), and there was no evidence of manipulation. In Audit 2, 57% and 51% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Thirty percent were considered to be yellow flags, 59% showed evidence of mobilisation, 100% showed evidence of diagnostic triage and did not recommend bed rest, 60% were referred for rehabilitation, and there was no evidence of manipulation. Changes instigated included new appointment and referral systems and new topics for staff education.
Conclusion
Auditing physiotherapy treatment notes of patients with low back pain has been shown to be useful in monitoring areas of good practice and in identifying practice in need of development. Clinical audit should be seen as a quality improvement process that aims to optimise patient care.
Citation
Treatment of low back pain: monitoring clinical practice through audit
Valerie Sparkes
Physiotherapy - September 2005 (Vol. 91, Issue 3, Pages 171-177, DOI: 10.1016/j.physio.2004.10.007)