On Monday 12th December at 8pm UK time we’ll be holding our last physiotalk tweetchat of the year.
Last week saw NICE publish updated guidance on the management of low back pain: Low back pain and sciatica in over 16s: assessment and management. Changes in recommendations have generated significant discussion on twitter, and as often the case with NICE there have been questions about the process the institute uses to produce guidance, as well as whose responsibility it is to implement the recommendations.
We’ll be discussing ‘what next’ – including approaches to implementing the guidance, and how services can use the guidance to review and improve services at a local level.
Who are NICE?
NICE (the National Institute for Health and Care Excellence) is an a Non Departmental Public Body. Its role is to improve outcomes for people using the NHS and other public health and social care services. They do this by:
- Producing evidence based guidance and advice.
- Developing quality standards and performance metrics.
- Providing a range of informational services including NICE Evidence.
NICE guidance is officially England-only. However, there are agreements to provide certain NICE products and services to other ares of the UK; and robust evidence-based guidance has significance for the profession globally.
NICE low back pain and sciatica guidance
The guidance replaces NICE’s low back pain guideline published in 2009. A number of changes have been made to recommendations, including:
- That clinicians consider using risk stratification tools to inform shared decision-making about referral for rehabilitation.
- Exercise, in all its forms at the heart of non-pharmacological interventions, and massage and manipulation should only be used alongside exercise.
- A number of non-pharmacological interventions are not recommended, including traction, electrotherapies, back support, and acupuncture.
- Combined physical and psychological treatments are recommended for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.
As always with NICE guidance we should suggest going straight to the published guidance before entering into on and off-line discussions as many misconceptions start without going to the original recommendations first.
Some questions to think about before the tweetchat:
- What do you like about the updated NICE low back pain guidance? What recommendations you are less sure about?
- How should physios and services go about using and implementing the guidance?
- Which recommendations could have the biggest impact on physiotherapy practice, services and patients?
- Which recommendations will be the most challenging to implement and why? What help will you need?
- If these are ‘Guidelines not tramlines’ – best practice guidance not mandatory standards – what freedom do physiotherapists have to deviate away from the recommendations?
- How can NICE guidance help us as a profession at a time of economic pressure and focus on service quality and efficiency?
- NICE guidelines put exercise at the heart of managing low back pain – Karen Middleton
- Clinical update: low back pain and sciatica – Neil O’Connell (summary of key recommendations)
- NICE Into practice guide
Other useful links
- The evidence used to develop the low back pain guidance
- History behind the guidance – including consultation and guideline development group
- Developing NICE guidelines: the manual: the published process NICE uses to develop its guidance.
Missed the chat? You can catch up with our transcript
Not quite an ELO song for this post title?