University of Otago researchers, together with their colleagues at AUT have been working to develop the stratified care model for management of low back pain (STarT Back) in New Zealand.  The model, which focuses on addressing psychosocial issues potentially relating to back pain, was originally developed in the UK.

Professor David Baxter from the University of Otago’s Centre for Health, Activity & Rehabilitation Research at the School of Physiotherapy, says low back pain is costly to New Zealand and improving patient outcomes is a priority.

Back disorders are one of the leading causes of health problems in New Zealanders aged from 15 to 64. Between 2012 and 2013, $326.8 million was spent treating back pain with indirect costs from loss of income and productivity ballooning the figure to about $2.6 billion, Professor Baxter says.

“It is recognised that psychosocial factors, such as patients’ beliefs that activity is harmful or a lack of support, are important predictors of poor outcomes for people with low back pain,” he says.

“STarT Back risk stratification represents a promising approach to better management of people with low back pain by matching treatment approaches to the presence or absence of psychosocial obstacles to recovery.”

STarT Back has been shown in the UK to improve patients’ phsycial function while reducing costs of care and is endorsed by the UK’s National Institute for Health and Care Excellence and NHS England, which provides funding for primary healthcare services in the UK.

Professor Baxter says the potential for implementation of this approach in New Zealand has been limited mainly because no clinically-practising physiotherapists have received the necessary training in psychologically-informed management required to manage the high-risk group of patients.

However, the University of Otago is running a workshop beginning today to train physiotherapists in this new model of care for patients with back pain. The University has been successful in securing funding from the Physiotherapy New Zealand Scholarship Trust and Otago & Southland Physiotherapy Trust to support a training programme, provided by the developers of the STarT Back programme from the UK.

One of the UK trainers will provide training for up to 20 physiotherapists at the workshop being held at the School of Physiotherapy from 10-14 June.  Following the workshop there will be monthly group-based mentoring via teleconference over six months.  At the end of three-months post-training, participants will be invited to a focus group to share their views and opinions towards the possibility of nation-wide implementation of the programme.

It should be noted that while it is the first time the STarT Back programme is being implemented here, a psychosocial approach to managing low back pain is not new to New Zealand. ACC guidelines indicate models of care incorporating a psychosocial approach have been updated since their first iteration in 1997. These models emphasise that care is delivered across health fields, not just by physiotherapists, with Occupational Therapists, Occupational Health Nurses, Psychologists, Occupational Physiotherapists, and Pain Specialists all playing an important role in workplace rehabilitation.


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