Clinical Care Standards 2021

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Low Back Pain Clinical Care Standard

The Low Back Pain Clinical Care Standard aims to improve the early assessment, management, review and appropriate referral of patients with this common health condition.

The national standard was released by the Commission on 1 September 2022.

National launch and live webcast

Experts in pain management, emergency medicine, physiotherapy and general practice discuss and explain the Low Back Pain Clinical Care Standard at its launch on 1 September 2022.

Communications resources

Show your support for the clinical care standard by downloading and sharing the content on your website, social networks or within your health service organisation.

To help you share and promote the clinical care standard within your networks, a
communications kit and launch presentation slides are available for download.

Presentation slides - Launch of the Low Back Pain Clinical Care Standard

2022

Presentation

Download the standard

Low back pain is a common form of back problem that affects most people at some point in their lives¹. As well as pain, it often leads to psychological distress and poorer quality of life^2,3.4 and is a leading cause of disability worldwide⁵.

Low Back Pain Clinical Care Standard (2022)

2022

Publication, report or update

The Low Back Pain Clinical Care Standard contains eight quality statements and eleven indicators to improve the early assessment, management, and review and referral of patients with low back pain.

Contents of the standard and resources

The Low Back Pain Clinical Care Standard includes:

Eight quality statements describing the care that should be provided
A set of indicators to support monitoring and quality improvement

Information and resources are available for consumers, clinicians, and healthcare services, or you can see the complete list of implementation resources.

Consultation and endorsement

The standard was developed in consultation with a topic working group of clinicians, researchers and consumers. Public consultation on the clinical care standard was carried out between March and April 2021.

The standard has been endorsed by 19 key professional associations and consumer organisations including the Australian College of Emergency Medicine (ACEM), Australian College of Rural and Remote Medicine (ACRRM), Australian Physiotherapy Association (APA), The Royal Australasian College of Physicians (RACP), Royal Australian and New Zealand College of Radiologists (RANZCR), Spine Society of Australia (SSA) and the Australian Pain Society (APS).

The standard is supported by the Consumer Health Forum (CHF) and the Royal Australian College of General Practitioners (RACGP).

Evidence base

Further information is available on the evidence base which underpins the Low Back Pain Clinical Care Standard, and the rapid literature and evidence review commissioned to inform the standard’s development.

Background

In Australia, back problems are the number one cause of lost work productivity, early retirement and income poverty.^6,7,8,9,10 In 2018–19, more money was spent on managing musculoskeletal disorders, including back problems, than any other category of disease, condition or injury in Australia.¹¹

The Australian Atlas of Healthcare Variation series has identified marked variation across Australia relevant to the care of low back pain, including in:

Computed tomography (CT) of the lumbar spine¹²

Opioid medicine use^12,13

Lumbar spinal surgery.^12,13,14

The Second Australian Atlas of Healthcare Variation (second Atlas) identified a need for comprehensive Australian guidance on the early management of low back pain, based on the National Institute for Health and Care Excellence guideline Low Back Pain and Sciatica in Over 16s: Assessment and management, and other relevant high-quality Australian and international evidence.¹⁴

The second Atlas recommended that the Australian guidance support appropriate early management, and ensure that patients are informed about and understand the range of treatment options available for low back pain, their risks and their likelihood of benefit.¹⁴

Improved uptake of guideline recommendations for management of low back pain has been shown to result in better patient outcomes, such as in the extent and rate of recovery and a reduced need for ongoing care.^15,16 It could also lead to more judicious use of imaging; lead to more appropriate use of opioids, other medicines and invasive therapies; and ultimately mean that more patients receive high‑value care.^7,17,18,19

References

List of references cited on this page

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028–37.
Apos E, Cunningham J, Ahern S, Truong T, Hansen J, Johnson MA. The Australian Spine Registry annual report, 2019. Melbourne: Spine Society of Australia and Public Health and Preventive Medicine, Monash University; 2020.
Australian Institute of Health and Welfare. Back problems. Canberra: AIHW; 2020.
Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord 2014;15(1):50.
Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1211–59.
da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 2012 Aug 7;184(11):E613–24.
NSW Agency for Clinical Innovation. Management of people with acute low back pain: model of care. Chatswood: NSW Health; 2016.
Schofield DJ, Shrestha RN, Passey ME, Earnest A, Fletcher SL. Chronic disease and labour force participation among older Australians. Med J Aust 2008 Oct 20;189(8):447–50.
Traeger A, Buchbinder R, Harris I, Maher C. Diagnosis and management of low-back pain in primary care. CMAJ 2017 Nov 13;189(45): E1386–95.
Schofield DJ, Shrestha RN, Cunich M, Tanton R, Kelly S, Passey ME, et al. Lost productive life years caused by chronic conditions in Australians aged 45–64 years, 2010–2030. Med J Aust 2015 Sep 21;203(6):260.e261–6.
Australian Institute of Health and Welfare. Disease expenditure in Australia 2018–19. Canberra: AIHW; 2021.
Australian Commission on Safety and Quality in Health Care, National Health Performance Authority. Australian atlas of healthcare variation. Sydney: ACSQHC; 2015.
Australian Commission on Safety and Quality in Health Care. The Third Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2018.
Australian Commission on Safety and Quality in Health Care. The Second Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2017.
Bogduk N. Management of chronic low back pain. Med J Aust 2004 Jan 19;180(2):79–83.
McGuirk B, King W, Govind J, Lowry J, Bogduk N. Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine (Phila Pa 1976) 2001 Dec 1;26(23):2615–22.
Ferreira GE, Machado GC, Abdel Shaheed C, Lin CC, Needs C, Edwards J, et al. Management of low back pain in Australian emergency departments. BMJ Qual Saf 2019 Oct;28(10): 826–34.
Layne EI, Roffey DM, Coyle MJ, Phan P, Kingwell SP, Wai EK. Activities performed and treatments conducted before consultation with a spine surgeon: are patients and clinicians following evidence-based clinical practice guidelines? Spine J 2018 Apr;18(4):614–9.
van Wambeke P, Desomer A, Ailliet L, Berquin A, Demoulin C, Depreitere B, et al. Low back pain and radicular pain: assessment and management. Brussels: Belgian Health Care Knowledge Centre; 2017. KCE Report 287.

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