ACSQHC’s Low Back Pain Clinical Care Standard

On 1 September the Australian Council for Safety and Quality in Healthcare (ACSQHC) released its Low Back Pain Clinical Care Standard.

The standard contains a number of quality statements that describe the level of clinical care expected for people presenting with low back pain, and by doing so aims to improve outcomes.

The ACA gave input into the development of the standard and endorses it. Back problems broadly are the number one cause of lost work productivity, early retirement and income poverty in Australia. The ACA believes the standard to be a significant body of work which will help address this burden.

 “A clinical care standard differs from a clinical practice guideline. Rather than describing all the components of care for a specific clinical condition or procedure, a clinical care standard focuses on key areas of care where the need for quality improvement is greatest.”

It places a biopsychosocial model to the forefront, looking to change practices which have been shown to be poorly supported by evidence. It has been developed with all points of primary care in mind, understanding the predominance of medical general practice.

The ACA does hold one reservation with the standard, that we have communicated consistently to the Commission. The ACA holds that, for chiropractors, Quality Statement 3 – Reserve imaging for suspected serious pathology is too restrictive.

As chiropractors we have developed, over many years, expertise in understanding the function of the spine. Practitioner experience may not always be fully available for capture in a standard/guideline process, particularly in a multidisciplinary context, yet it remains a key component of evidence-based practice.

By nature of the mode of care used by chiropractors (hands-on, physical), the utility of imaging for chiropractors may be different to that of other practitioners. In addition to the incidence of serious pathology, factors such as anatomical variants, degree of degeneration, and biomechanical factors have long been incorporated into the decision-making process of chiropractors, with the intention of optimising patient outcomes.

ACA policy on imaging, keeping clinical decision-making at the forefront, within an evidence-based context, is consistent with Chiropractic Registration Board guidelines.

The ACA encourages its members to digest the standard as an aid within the context of chiropractic practice, when people present with lower back pain.

To access the Standard, click here.