The Learning to Improve the Management of Back Pain in the Community (LIMBIC) model emerged from an educational intervention with primary care practitioners working in teams which also included patients and where the focus was learning about the principles of quality improvement alongside learning about doing quality improvement.
The LIMBIC model is based on the premise that the best way to learn about improvement is for teams to be supported to actually do improvement in practice. We believe the following elements to be key learning activities for Practice teams:
listening to patients to understand their needs better
focussing on topics that feel important to patients and Practice teams
learning with patients about how care is provided and whether it matches their needs and reflects best evidence; thus identifying areas for improvement that add value
testing small and simple improvements that can be implemented quickly and easily in practice using feedback measures that are relevant and helpful
reviewing the results regularly and responding to them to maintain continuous improvement as a way of Practice life
ensuring learning takes place in a mutually respectful environment
Improvement Leaders' Guides - NHS Institute for Innovation and Improvement 2005. Telephone: 0870 066 2071 and quote NHSI 0391 N CI/Improvement Leaders' Guides
How to change practice - this NICE guide aims to improve patient care by giving practical advice on how to encourage healthcare professionals and managers to change their practice in line with the latest guidance.
Sheffield Back Pain Website - this website has been put together by Sheffield clinicians with a special interest in managing back pain. They include GPs, physiotherapists, spinal surgeons, rheumatologists, chiropractors, osteopaths and acupuncturists.
The Working Backs Scotland site has a good page
The European Back Pain Guidelines - the main current evidence and consensus-based guideline. Published in 2005. Contains separate guidance on the management of acute (first 12 weeks of an episode) and chronic (>12 weeks) back pain plus the prevention of low back pain.
There is a BMJ Learning online training module provided by BackCare now available. You will have to register on their site, but accessing this course on the management of acute back pain is free.
NZ guidelines for assessing psychosocial yellow flags for acute low back pain.
The Health and Work Handbook, published by the Faculty of Occupational Medicine, the Society of Occupational Medicine and the Royal College of General Practitioners in 2005. This discusses the benefits of work for health and ways of optimising working relationships between GPs, employers, occupational health professionals and patients.
Physiotherapy Journal has published an interesting article on patient centredness in physiotherapy from the perspective of a chronic low back pain patient. Communication seems to be crucial in ensuring patient cented services, see abstract in Physiotherapy 2008; 94(3):244-52
Complementary medicine - a booklet on complementary medicine from the Department of Health
The Back Book - a guide for patients based on the latest research. It should be suitable for anyone with back pain, and doctors or therapists may give it to their patients to help with early management. It is linked with the Royal College of General Practitioners and the Faculty of occupational Medicine guidelines for back pain.
Patient Leaflet - example of a patient leaflet (adapted from Adenbrookes) [Word]
