Determining the Impact of a New Physiotherapist-led Primary Care Model for Low Back Pain

Measured using the Roland Morris Disability Questionnaire (0 to 24 with higher scores indicating greater disability)

Measured using a numeric pain rating scale from 0 to 10 with higher scores indicating greater pain intensity (measured at rest, during walking, and during a lifting task)

Measured using the EuroQoL-5D-5L (0 to 100 with greater scores indicating greater self-reported health related quality of life)

Confidence in abilities to participate in usual activities using the Pain Self Efficacy Questionnaire (0-60 score with higher scores indicating higher level of confidence in dealing with pain)

Measured using an 11-point scale (-5 to +5 with negative scores indicating a worsening of physical functioning related to back pain and positive scores indicating an improvement of physical functioning related to back pain)

Measured using an 11-point scale(-5 to +5 with negative scores indicating a dissatisfaction with health care received and positive scores indicating satisfaction with health care received)

Measured using the Tampa Scale of Kinesiophobia (TSK-11) [an 11-item questionnaire]. Score of 11-44 with lower scores indicating less pain-related fear. The initial protocol indicated our intention to use the TSK-17, but we changed to the TSK-11 to reduce response burden prior to initiating patient recruitment.

Measured using the Pain Catastrophizing Scale (0 to 52 with higher scores indicating greater catastrophic thinking)

Measured using the 2-item Patient Health Questionnaire (PHQ-2) (0 to 6 with greater scores indicating increased depressive symptoms). This measure was changed from the PHQ-9 to PHQ-2 after initial trial registration but prior to initiating patient recruitment reduce response burden.

Measured using an adverse events questionnaire that asks 1) if the patient has experienced any adverse events as a result of the treatments received (yes/no); 2) how long the event lasted (hours or days); 3) how severe the adverse event was (0-10 scale); 4) what adverse events were experienced.

Percentage of patients receiving care within 48 hours.

Percentage of patients who score medium or high risk on the STarT Back tool who receive physiotherapy care.

Measuring health care utilization, from the participant's EMR, of consultations with primary care team members and access to programs offered within primary care

Measuring health care utilization (self-report survey): visits to health professionals outside of the primary care team (e.g. chiropractors, massage therapists, occupational therapists, physiotherapists, social workers), medication use, and visits to walk-in clinics.

Measuring health care utilization from self-report survey: diagnostic imaging for the spine, pain injections or interventional procedures received, specialist visits for low back pain, hospital stays related to back pain and dysfunction, and emergency department visits for back pain. The collection of this healthcare utilization data changed from using health administrative data in Ontario accessed through the Institute for Clinical Evaluative Sience (IC/ES) to using a self-report survey prior to the initiation of patient recrutiment when we recruited sites in British Columbia.

Includes all health care costs (including: primary care visits, emergency department visits, hospitalizations, surgeries, consultations with other health care providers, diagnostic imaging, medications, and other care received by the patient) plus societal costs using a human capital approach for loss of productivity.

Measured as a process outcome - medications prescribed for back pain will be collected in table format from the EMR.

Measured as a process outcome - the number of diagnostic imaging tests ordered will be collected in table format from the EMR.

Measured as a process outcome - the number of referrals made to other health care providers will be collected in table format from the EMR.

Measured as a process outcome - the number of notes written to employers or insurers will be collected in table format from the EMR.

Measured as a process outcome (yes or no) and collected in table format from from the EMR

Measured as a process outcome and collected in table format from the EMR

Self-reported time lost from work, volunteering, homemaking, and educational activities

Self-reported assistance needed, due to LBP, for self-care, housework, shopping, or transportation. Participants indicates on survey what they needed assistance for.

Any extra expenses incurred as a result of LBP. Self-report

Measured at baseline using the Functional Comorbidity Index (an 18-item list of comorbidities that are associated with physical functioning).

To describe the study population, the investigators will capture the following through the survey: age, sex, gender, identification as indigenous (First Nations, Inuit, Métis), duration and history of LBP, level of education achieved, household income, and work status.

Measured using the STaRT Back tool to group participants into low, medium, and high risk groups

Self-report adherence to physiotherapy advice