Quality statements – Low Back Pain Clinical Care Standard

The Low Back Pain Clinical Care Standard contains eight quality statements describing the care that should be received by patients aged 16 years and over who present with low back pain, with or without leg pain.

It may be applied in all healthcare settings where such care is provided, but is particularly relevant to primary healthcare services and emergency departments.

Quality statements

The quality statements describe the expected standard for key components of patient care. By describing what each statement means, they support:

  • Consumers to know what care may be offered by their healthcare system, and to make informed treatment decisions in partnership with their clinician
  • Clinicians to make decisions about appropriate care
  • Healthcare services to understand the policies, procedures and organisational factors that can enable the delivery of high-quality care.

Some quality statements are linked to indicators to support monitoring of quality improvement.

Goals of the standard

This standard aims to:

  • Improve the early assessment, management, review and appropriate referral of patients with low back pain
  • Reduce the use of investigations and treatments that may be ineffective or unnecessary in managing low back pain.

Scope

This clinical care standard relates to the care that should be received by patients aged 16 years and over who present with low back pain, with or without leg pain. It covers the early clinical assessment, management, and review and referral of people with low back pain symptoms who present with a new acute episode.

Although this standard does not cover the ongoing management of chronic low back pain, it does include the early management of patients with an acute episode, recurrence or exacerbation of chronic low back pain; such patients may progress more quickly to referral and further assessment.

Application to healthcare settings

This clinical care standard applies to all healthcare settings where such care is provided, especially:

  • Primary healthcare services
  • Emergency departments.

The clinical care standard is of particular relevance to:

  • General practitioners
  • Allied health providers, including physiotherapists, pharmacists, psychologists, chiropractors, occupational therapists, osteopaths and paramedics
  • Emergency physicians
  • Nurses and nurse practitioners.

It may also be relevant in other specialist services that provide care within the scope of this standard.

Not all quality statements in this clinical care standard will be applicable to every healthcare service or clinical unit. Healthcare services should consider their individual circumstances in determining how to apply each statement.

Implementation should consider the context in which care is provided, local variation and the quality improvement priorities of the individual healthcare service.

What is not covered

This clinical care standard does not cover:

  • Delivery of surgical interventions or their indications for use (for example, fusion and disc replacement, discectomy, laminectomy)
  • Ongoing management of low back pain persisting longer than 12 weeks, beyond the initial management of an acute exacerbation (although many of the principles of care described may still be relevant)
  • Diagnosis or treatment of specific causes of low back pain, such as
    • inflammatory conditions (for example, axial spondyloarthritis)
    • infections (for example, discitis, osteomyelitis, epidural abscess)
    • fracture
    • neoplasm
    • metabolic bone disease (for example, osteoporotic fracture, Paget’s disease)
    • non-spinal causes of back pain
    • degenerative spinal disorders.