What the standard says
The assessment of a patient with a new presentation of low back pain symptoms, with or without leg pain or other neurological symptoms, focuses on screening for specific and/or serious pathology and consideration of psychosocial factors. It includes a targeted history and physical examination, with a focused neurological examination when appropriate. Arrangements are made for follow-up based on an evidence-based low back pain pathway.
What this means for you
Early assessment should include a targeted history of symptoms, including attention to the pain, past history, functional capacity and alerting features for specific and/or serious pathology. Consider differential diagnoses – for example, nephritis, colitis, hip osteoarthritis and aortic dissection.
Physical examination should include a postural assessment, bony and soft tissue palpation for tenderness and tone, and movement assessment for range and associated pain. A physical examination supports diagnosis and can help to build the patient’s confidence in the therapeutic relationship.
Consider using an evidence-based low back pain pathway that guides the appropriate assessment of patients who present with low back pain symptoms. The pathway should incorporate screening for specific and/or serious pathology. It should allow the use of validated tools, such as the Brief Pain Inventory (short form) or the Clinically Organized Relevant Exam (CORE) Back Tool, to aid assessment and monitoring of the patient’s progress. It should also allow referral to specialist clinicians, when needed, for management.
For acute leg pain without severe or progressive motor weakness, initial management should be the same as for acute low back pain.
For patients with low back pain symptoms and/or leg symptoms where there is clinical suspicion of neurological impairment, include a focused neurological examination with straight leg raise, deep tendon reflexes, and strength and sensation testing.
Arrange appropriate investigation or intervention if alerting features of specific and/or serious underlying pathology are identified. The presence of multiple alerting features is associated with a greater likelihood of serious pathology compared with the presence of a single alerting feature. Emergency assessment or referral is indicated for clinical signs of spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs or symptoms, suspected spinal infection or cauda equina syndrome, spinal tumour, trauma or fracture.
Determine the most likely diagnosis, document the assessment findings and communicate them to the patient. Arrange follow-up for monitoring or further assessment. Reassess at subsequent visits to check for symptom progression or any new concerning features that need urgent investigation or specialist assessment (refer to Quality statement 8 – Review and referral).