Review of the Clinical Outcomes of the Hong Kong West Cluster Multidisciplinary Non-Specific Back and Neck Pain Rehabilitation Program

Introduction

The orthopedic team launched the multidisciplinary Non-specific Back and Neck Pain Rehabilitation Program(BNPP) in 2017, aiming to enhance the clinical management and rehabilitation protocol to patients with back and neck pain. Patients were included if their pain was not attributed to specific pathology (e.g. infection, tumor, osteoporosis, lumbar spine fracture, structural deformity, inflammatory disorder or cauda equina syndrome). The clinical management enhanced rehabilitation and facilitated appropriate continuity of care to specialist after discharge. The BNPP team involved Orthopedic doctors, Pain nurse, Physiotherapist(PT), Occupational Therapist(OT) and Clinical Psychologist(CP) in QMH and MMRC.

Objectives

To review the clinical outcomes of BNPP in 2018

Methodology

Patients were transferred to MMRC after screening by orthopedic doctors or nursing consultant in QMH. The multidisciplinary intervention in MMRC condensed to a two-week program with psycho-educational classes, pain management with analgesic medication, active training, work preparation and timely review. The intensive training from PT, OT and CP were scheduled for at least 3 hours daily. Clinical outcomes included Numeric Pain Rating Scores(NPRS), Patient Specific Functional Scale(PSFS), Roland Morris Disability Questionnaire(RMDQ), Global Rating of Changing Scale(GCRS), Modified Barthel Index(MBI), Lawton’s Instrumental Activities of Daily Living(IADL), Oswestry Disability Index(ODI) would be rated before and after the program. Return to work rate and readmission rate were also reviewed in this report.

Results & Outcome

A total of 222 patients were recruited (male 50.7% and female 49.3%, mean age 56,). The average length of stay(LOS) was 9 days. There were significant improvement in NPRS of 4.7(Z=-11.8, p< 0.001), PSFS of 4.8(Z=-12.375, p< 0.001) and RMDQ 8.3(Z=-12.3, p< 0.001). Significant functional improvement was gained in MBI and IADL scores of 5.7(t=6.6, p< 0.001) and 4.7(t=8.4, p< 0.001) respectively. The ODI also had significant improvement with 20.8% reduction in disability(t=12.8, p< 0.001). The average GRCS was 63%. 34% of patients were assessed and triaged to orthopedic specialty follow-up, whereas 54% referred to family medicine. The return to work rate was 73.6% and 30-day readmission rate was 3%. In conclusion, the Orthopedic doctors led BNPP had successfully applied to patients with back and neck pain with satisfactory clinical outcomes.