TalkBack, winter | 2020 (BackCare)

Quarterly magazine of BackCare, the UK’s National Back Pain Association

WINTER n 2020

FREE TO MEMBERS

also in this issue: Covid update How the pandemic has changed our priorities Standards and statistics Headaches – new quality standard for chiropractors

How to stay active at home this winter

Workplace Using health monitoring to reduce workplace MSDs

www.backcare.org.uk

2 TALKBACK NEWS

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Leave a gift to a cause close to your heart Generous gifts from legacies enable campaigning charities like BackCare to continue to help people in pain.

BackCare works hard to assist everyone with back pain, providing support, undertaking research, and producing resources to promote better health. That’s why we are asking for your help.

Leaving a gift in your will to BackCare is a relatively simple act that can make a big difference.

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To receive our legacy pack call 020 8977 5474 or find out more on our website backcare.org.uk/get-involved/donate-backcare

TALKBACK l WINTER 2020

TALKBACK LEADER 3

How to stay active through the winter ACCESS to Covid-19 vaccines is now tantalisingly close. However, restrictions remain in place and it is as important as ever to maintain our physical and mental health and well-being over the winter.

Many people have no intention of returning to group activities while coronavirus remains a threat, and online communities have proved invaluable at helping to keep us active.

Sport England has produced a range of resources (p8/9) to help individuals, clubs and organisations find free online content on ways to stay active in and around the home.

There is a vast range of online classes and exercises to choose from so finding an activity you like shouldn’t be difficult.

These range from structured workouts for strength and stamina – to shorter sessions to help you stretch and move. For the less able there is also a series of sitting exercises designed to improve balance and flexibility.

For anyone able to access a garden or public space (weather permitting), walking is one of the easiest ways to start moving more. Cycling, too, is a great way for the family to get active outside, and tips and advice can be found on where to do this locally in a safe and responsible way.

The past year has been especially challenging for people with long-term conditions whose regular support and

Contents

health services have been severely curtailed.

Worryingly, inactivity among this group was found to have increased by 11% between March and May1.

A new campaign, We Are Undefeatable, aims to help those with long-term conditions get moving again. The initiative, which is led by the major health charities, inspires people to be physically active in any way that works for them by sharing real life stories and experiences, and highlights virtual teams you can get involved with at home.

The new year is usually a time to reflect and decide upon changes we’d like to make in our lives. How about trying a new activity that you can enjoy safely – you’ll find that even small increases in physical activity can make a big difference to your mood.

Richard Sutton Editor

People in deprived areas more likely to visit A&E 5

Programmes not preventing fractures 12

Managing MSKs while waiting for treatment 14

LETTERS TO THE EDITOR:

richard.sutton@backcare.org.uk

Cover image: ArthurHidden/Freepik

1) Active Lives Adult Survey, Sport England

We welcome articles from readers, but reserve the right to edit submissions.

Paid advertisements do not necessarily reflect the views of BackCare. Products and services advertised in TalkBack may not be recommended by BackCare. Please make your own judgement about whether a product or service can help you. Where appropriate, consult your doctor. Any complaints about advertisements should be sent to the Executive Chair.

All information in the magazine was believed to be correct at the time of going to press. BackCare cannot be responsible for errors or omissions. No part of this printed publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the copyright holder, BackCare. ©BackCare

BackCare BackCare, Monkey Puzzle House, 69-71 Windmill Road, Sunbury-on-Thames TW16 7DT Tel: +44 (0)20 8977 5474 Email: info@backcare.org.uk Website: www.BackCare.org.uk Twitter: @TherealBackCare Registered as the National Back Pain Association charity number 256751.

TalkBack is designed by Pages Creative www.pagescreative.co.uk and printed

by Severn, Gloucester.

Delayed diagnosis of axial SpA can ruin lives 16

Monitoring device to track workers’ posture 22 TALKBACK l WINTER 2020

4 TALKBACK NEWS

Image: jcomp/freepik

Virtual race runners raise £4,500 in the fight against back pain

HATS OFF to BackCare’s fantastic supporters for completing October’s virtual London Marathon – and raising more than £4,500 for the charity in the process!

Undeterred by the hugely disappointing cancellation of the 2020 road race, our virtual runners managed to put their hard months of training to good use and completed the 26.2 miles on alternative courses closer to home.

Their individual achievements have earned them a coveted finisher medal while they retain the option to compete in a future London Marathon in 2021, 2022 or 2023.

Team BackCare Our warmest congratulations and thanks go to Carl Bailey, Andy Garrett, Jane Morgan, Nicola Brammer, Paul Roberts, Richard Potter, Sarah Millington, Amanda Waters, Vida Spiller, Michelle Carr, Zoe Hughes, Hamedah Shkokani, Kate Lancefield, Rosemary Copsey, Jonathan Crocker, Paul Jones, and Mary Hockenhull.

The 2021 Virgin Money London Marathon is scheduled to take place on Sunday, October 3. According to the organisers, a total of 219,893 people have

applied in the ballot for a place! If you are interested in running for BackCare in 2021 or beyond, please email events@backcare. org.uk

FIGURES published by Health Education England (HEE) show the highest ever number of GPs entering training with 3,793 posts accepted, exceeding the mandated target of 3,250.

HEE says it has increased GP trainee acceptances year on year for the last seven years. This figure represents a 40% increase on the figure of 2,700 recruits when HEE started its recruitment drive back in 2014.

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Dr Navina Evans, Chief Executive, Heath Education England, said: “The NHS Long Term Plan is very clear that patient care needs to be delivered closer to home wherever possible, and that’s why this news is so important, and why we have made this one of our key priorities.”

The Department of Health and Social Care aims to deliver an extra 50 million appointments a year.

Image: standret/freepik

Record numbers of GP trainee acceptances

TALKBACK NEWS 5

THERE were almost twice as many attendances to A&E departments in England for the 10% of the population living in the most deprived areas (3.1 million), compared with the least deprived 10% (1.6 million) in 2019-20, according to latest official figures.

The report by NHS Digital1 shows that attendances for the 20% of the population living in the most deprived areas accounted for 27% of all A&E attendances (5.9 million attendances).

The data also reveals that Monday is the busiest day of the week, accounting for 16% of all attendances during 2019-20 (3.63 million attendances). The most frequent time of arrival on a Monday is between 10am and midday, accounting for 15.2% of attendances on this day (552,000 attendances). The number of

Image: mrsiraphol/freepik

People in most deprived areas almost twice as likely to visit A&E

reattendances to A&E within seven days was 1.95 million and accounted for 8.7% of all reported attendances.

1) Hospital Accident and Emergency Activity 2019/20

Attracting a new generation of osteopaths CHOOSE Osteopathy is a new digital media campaign that has been targeting young people and career changers to consider a career in osteopathy. The campaign has been devised by the Osteopathic Communications Network to coincide with the period prospective students consider their UCAS applications for next year’s university places.

The campaign showcases real osteopaths and their personal stories, expressions of their passion for osteopathy and the rewards of being an osteopath. There is a dedicated webpage, social media assets and videos.

Katie Griffiths, iO Head of Marketing and Communications, said: “We are targeting 16-23 year-olds and those seeking a change of career into health using digital and social platforms to drive awareness.

“We have a number of young and passionate osteopaths providing videos and testimonials to really engage young people into choosing osteopathy as a career – so all round this has been a great example of how people have collaborated across our profession.” www.iosteopathy.org

ORGANISATIONS are invited to apply for funding to set up a pain research data hub.

The hub will be part of the UK Research and Innovation (UKRI) and Versus Arthritis Strategic Priority Fund Advanced Pain Discovery Platform.

It will bring together and curate data sets to provide high-value data resources.

UK research organisations eligible for UKRI funding include higher education institutions, approved independent research organisations, approved NHS bodies, and research council institutes. www.ukri.org.

Rheumatology workshop at RCN

Image: freepik

Enabling nursing staff to talk openly about concerns THE Royal College of Nursing has produced a new tool to help nursing staff feel confident to talk openly about errors and risks to patient care.

Concerns might include an inability to meet the care of patients in your caseload, an inadequate response to a reported incident, or suspicions of fraud or bullying.

The guidance includes a flowchart to help staff decide what action to take if concerns need to be escalated.

Eileen McKenna, Associate Director of Nursing, Policy and Professional Practice, said: “Any delay in reporting concerns could have a negative impact. It’s important to remember that it’s in everyone’s best interest – patients, staff and managers – to identify when something isn’t right, learn from this and make improvements.”

£2m funding for pain research

THE Royal College of Nursing (RCN) is running a rheumatology workshop on 19 March 2021.

The educational opportunity follows the publication earlier this year of the RCN’s Competency Framework for Rheumatology Nurses, supporting role development for practitioners in clinical practice.

The role of the rheumatology nurse specialist is highly complex and may include roles in paediatric nursing, research, advanced level skills in clinical assessment and prescribing and providing intra-articular injections. www.rcn.org.uk

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6 TALKBACK CASE STUDY

Empowering osteoporosis patients University Hospitals Bristol and Weston NHS Foundation Trust was a winner in this year’s British Society for Rheumatology Best Practice Awards, achieving recognition for an innovative project to help empower osteoporosis patients and drive down the number of hip and spine fractures.

“Do the survey and get buy-in from patients”

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Images: kjpargeter/freepik

DEBILITATING spinal and hip fractures are becoming a growing problem as the population ages. They’re devastating and painful for patients and are proving increasingly costly to the NHS and social care. The rheumatology unit at University Hospitals Bristol and Weston NHS Foundation Trust was seeing an increasing number of osteoporosis patients asking questions about thin bones, including how to avoid them, what food they should eat and what exercises they should do.

The team, led by consultant rheumatologist Dr Shane Clarke, developed a survey in 2015 for patients coming to the osteoporosis clinic and those having a bone density scan.

Dr Clarke explains: “We didn’t know what the best way to help our patients would be. Our survey helped us to understand that patients wanted to be able to improve their knowledge and learn practical tips to help manage their condition.

Half of respondents were keen for regular hourlong sessions and the others wanted half-day sessions, so they didn’t have to come back and forth to the hospital.”

The team, including osteoporosis clinical nurse specialist Terrie Stocker and consultant Dr Matt Roy, developed a six-week course with each 60-minute session divided into two.

Dr Clarke says: “The first half would deal with one aspect of thin bones, such as nutrition, diagnosis of osteoporosis, how to interpret DXA results and fracture risk, what medications are available, their advantages and potential adverse

events. The second half was devoted to tailored group exercise.”

Physiotherapist Katrina Hutchins developed exercises to improve patients’ core strength and a 12-station activity circuit including tai-chi, Pilates, strengthening and balance exercises, relaxation, and a practical session on getting up off the floor after a fall. Dr Clarke said: “The whole idea was to see whether we could encourage people to carry on with the exercises at home once they’d completed the course.”

The half-day courses allowed them to include a session with a dietitian and support from an occupational therapist. The team partnered with the Royal Osteoporosis Society (ROS) who supported them with administration, signposting patients and providing trained volunteers who came into clinics to talk to patients.

Once four of the courses had been run over the first year, the team brought 37 “alumni” patients back together to reflect on what had gone well, what needed to change and to find out how many were still exercising.

Dr Clarke said: “They retained most of their osteoporosis knowledge, but their confidence in continuing to exercise had waned. After the review we altered the balance of the courses to focus on a medium-term aim to continue exercising at home. By the time of the second alumnus meeting, which was very well attended, the majority had continued to exercise regularly.”

More than 200 patients have now been through the courses and hip fracture rates locally have reduced. As well as the Best Practice Awards, the team has been particularly recognised for Outstanding Patient Involvement.

Dr Clarke says: “The main thing is that people who go through the course feel less frightened by fractures. What we’re trying to do is get people to go out and have a good quality of life, rather than sit at home worried about breaking bones. This award win is great for the team, but it’s a clear reflection on all the hard work put in by our Royal Osteoporosis Society volunteers too.”

The team recognises that men were underrepresented on the courses. It’s now working on a new venture to get more regular exercise into

TALKBACK CASE STUDY 7

Image: rawpixel.com/freepik

and reducing fractures

commended how patient feedback helped shape improvements.

Dr Clarke’s advice to other clinics is that you need to survey your patients: “It would be nice to say if you introduced this everywhere it would work, but each area is different. Do the survey and get buy-in from patients. After each course, we always collected information from patients aiming to make the content more relevant and helpful for subsequent groups. Getting it right for your local community is what it’s all about.” www.rheumatology.org.uk www.uhbristol.nhs.uk www.theros.org.uk www.versusarthritis.org

the community, particularly to include older men. The team is linking with Gloucester County Cricket and cricket writer Scyld Berry to introduce cricket games between residential homes in Bristol using specially manufactured softballs that can’t cause fractures, once the pandemic is over.

Dr Clarke said: “It’s about engaging people to continue exercising into their 70s, 80s and 90s – the health and social benefits are beyond doubt.”

Chair of the judging panel and British Society for Rheumatology president, Dr Elizabeth Price, believes the project stood out from the crowd. She said: “It’s such a simple idea and it really captured my imagination. It delivers education and practical help with appropriate exercise in a group setting for those with osteoporosis.

The team has worked collaboratively with the Royal Osteoporosis Society and developed a very cost-effective, reproducible service model.”

Four volunteers from the charity Versus Arthritis, who all have lived experience of arthritis and accessing health services, helped judge the entries. They gave the team full marks for exceptional patient involvement, highlighting that patients were central to the design of the project and

Images: kjpargeter/freepik

Reproducible service model

The challenge Osteoporosis affects more than 3 million people in the UK, and more than 500,000 people a year receive hospital treatment for fragility fractures resulting from osteoporosis1.

Patients who are at high risk of fracture require targeted education to explain their condition and what steps they can take to self-manage it through medication and exercise.

Education programme Participants gain knowledge to help them understand their osteoporosis and the practical steps they can take to reduce their risk of a fragility fracture and minimise the effect a fracture might have on their daily life if they do break a bone.

Exercise programme Promoting the ROS ‘Strong, Steady and Straight’ guidelines, for exercise in patients with osteoporosis, participants gain practical experience and confidence in doing exercises that improve bone strength as well as balance and stability that can reduce the risk of falls.

1) NHS. Overview: Osteoporosis. 2019 (www.nhs.uk/ conditions/osteoporosis)

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8 TALKBACK PHYSICAL ACTIVITY

Great ideas for staying active To help you keep your sports and physical activity going through the winter, Sport England has produced an Activity Toolkit that’s packed with resources and information.

SPORT ENGLAND’S Activity Toolkit brings together the latest advice and guidance on what is and isn’t allowed and a range of assets to help organisations and individuals. You can use the materials as they are or adapt them with local imagery and calls to action.

The toolkit also connects you to the best and most recent insight about the way people are feeling about sport and physical activity in the current climate, as well as how you can join up with Sport England’s three existing campaigns, This Girl Can, We Are Undefeatable and Join the Movement.

It offers outdoor activity advice, with tips and guidance on getting active away from home safely and in line with the regulations. There are resources for helping you be active– with a selection of online exercise platforms providing free access or extended trials. You can Join the Movement and share how you’re getting active during this time.

GET ACTIVE AT HOME

Nike Training Club Nearly 200 free workouts across strength, endurance, yoga and mobility. Sessions range from 15-45 minutes and are designed to help you see and feel results. www.nike.com/gb/ntc-app The Body Coach The home of Joe Wicks’ workouts with hundreds available for all fitness levels.

These fun workouts can be done at home with no equipment. www.youtube.com/channel/ UCAxW1XT0iEJo0TYlRfn6rYQ Yoga with Adriene High quality practices on yoga and mindfulness to inspire people of all ages, shapes and sizes across the globe. www.youtube.com/user/yogawithadriene Rachel Lawrence Pilates Pilates instructor Rachel Lawrence shares her expertise in a warm, friendly style with a wide range of classes to inspire, inform and challenge. www.youtube.com/channel/ UCIfUrFyAWGeB6kMaEVRqR5Q

Image: freepik

Roll out the... get active at home

Online communities can help people with long THE Sport England-funded campaign We Are Undefeatable is encouraging people with long-term health conditions to keep active in the face of coronavirus restrictions.

The campaign, which is led by 15 major health charities and inspires people to be physically active in any way that works for them by sharing real life stories and experiences, is promoting Team Undefeatable which is made up of virtual teams people can get involved with at home.

Former England international footballers Emile Heskey and Kelly Smith have backed the initiative, which comes at a time when new figures have revealed the impact

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lockdown had on activity levels during the early part of the pandemic.

The most recent Active Lives Adult Survey revealed that inactivity rose by 11% for people with long-term health conditions between March and May, with a quarter of people living with such a condition saying they will not return to communal sport and leisure centres until there’s a vaccine, or coronavirus is no longer a threat in the UK. This is despite widespread understanding that regular physical activity can reduce the risk of developing some long-term health conditions by up to 40%. Regular bouts of exercise also help improve immune function and reduce systemic inflammation, leading

researchers to suggest that physical activity could reduce the severity of coronavirus symptoms and shorten recovery times.

Online communities can help people to keep moving when many of the activities they normally enjoy are no longer available in an accessible form.

Walking football and dance programmes are available on the We Are Undefeatable website and there are handy tips for setting up a virtual team, as well as advice for coaches on how to tailor sessions for people living with health conditions.

Inclusive dance teacher Katie Mason has been involved with a dance squad that

TALKBACK PHYSICAL ACTIVITY 9

this winter – and they’re free!

GREAT ACTIVITIES FOR OLDER ADULTS

10 Today A set of fun, 10-minute audio and video workouts, intended to easily fit into your day, that help get you stretching and moving at home. https://10today.co.uk/tune-in/ Move it or Lose it A series of fitness videos for older people by exercise instructor Julie Robinson. www.youtube.com/user/MoveitorloseitUK NHS sitting exercises These sitting exercises are great for all ages, but particularly if you’re over 65. Click on the button below to also find strength, balance and flexibility exercises. www.nhs.uk/live-well/exercise/sittingexercises Image: freepik

EXERCISE WITH THE KIDS

WALK, RUN OR RIDE

Disney workouts A chance for parents and kids to get moving to the songs they love. Learn their moves or put your own spin on their routines. www.thisgirlcan.co.uk/activities/disneyworkouts/

Couch to 5k A nine-week programme of podcasts that does exactly what it says on the tin – taking you from the couch to running 5kms.

Consisting of three runs a week, the programme gradually builds up intensity and gives you a choice of coaches – from the NHS’s Laura, to multiple Olympic champion Michael Johnson. www.nhs.uk/live-well/exercise/couch-to5k-week-by-week/

Get Kids Moving A selection of workouts that put the fun back into fitness and help engage kids.

Children can train alongside their favourite superheroes from the comfort of their home. www.youtube.com/channel/ UCokO71NW3TgndaSNyHIqwtQ

Image: master1305/freepik

Walking Walking is one of the easiest ways to get active, if you can access your garden or public space and are able to follow the government guidelines on social distancing. www.thisgirlcan.co.uk/activities/walking/

Let’s Ride Local British Cycling have created a tool to encourage safe and responsible cycling – the website includes tips and advice on riding locally, as well as instructions on teaching children how to ride. www.letsridelocal.co.uk/ www.sportengland.org/jointhemovement

Follow exercise and dance moves at home... or step up the pace outdoors

includes eight women living with various long-term health conditions such as MS, cancer, cerebral palsy and osteoporosis.

“Our classes were a time when the individuals could just think about dancing and enjoy the feeling rather than worry about what they may be going through. I’d urge anyone to set up their own groups, find an online or in-person group (if allowed to do so), or just follow some moves and dance alone.”

The squad, who had been rehearsing on Zoom together for 10 weeks, decided to surprise their friends and family with a virtual dance performance. https://weareundefeatable.co.uk

Image: master1305/freepik

term conditions

Many will not return to communal sport until the vaccine is available

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10 TALKBACK COVID UPDATE

Study reveals how pandemic has changed Will life ever be quite the same again once the pandemic ends?

Not for many of us, it seems...

Lifestyle changes feel less feasible for people with lower household incomes

A Covid-19 Social Study conducted by UCL Epidemiology & Health Care found that, while just over half (51%) of people felt they were more likely on balance to return to how things were before lockdown, a fifth (22%) felt they were more likely to change things and this rose to around a quarter in those aged 3059 (25%) and for those with a diagnosed mental illness (26%).

The factor that people were most likely to change was increasing their support for local businesses (40%), with around a third of people also saying they would save more money (33%), exercise more (35%) or make more use of online shopping (33%). A quarter of adults expressed a plan to work from home more; this increased to nearer a third (29% of 18-29 year-olds and 32% of 30-59 year-olds) when excluding those over the age of 60.

The ongoing study is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). It is the UK’s largest study into how adults are feeling about the lockdown, government advice and overall wellbeing and mental health with more than 70,000 participants

More people aim to holiday in the UK who have been followed across a period of 23 weeks.

A quarter (26%) of people across all age groups also reported wanting to spend more time with family outside of their homes, or holiday more in the UK. Just under a fifth (18%) of people aged 18-29 also

expressed a desire to find a new romantic relationship once the pandemic is over.

Lead author Dr Daisy Fancourt said: “Our study shows that during lockdown many people’s priorities have changed, with a substantial number of people expressing a

Coronavirus will cause a huge shortfall in medical MEDICAL research charities are expected to lose almost 38% of their fundraising income this year, and more than 25% next year, according to the Institute for Public Policy Research (IPPR).

Restrictions on fundraising events, charity shop closures and wider economic uncertainty are all contributing to these losses, according to the think tank.

The IPPR estimates that this lost charity income and the adverse economic conditions will cause a cumulative £7.8 billion shortfall

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in health research and development (R&D) investment between now and 2027 – equal to 10% of UK health R&D. These figures constitute a “reasonable worst-case scenario” according to the researchers. However, even in the “bestcase scenario” the study predicts £4.5 billion less R&D investment – £2 billion of which is attributable to lost charity income.

Ultimately, this will lead to fewer treatments for patients, warns IPPR. Commenting on the forecast, British

Heart Foundation’s chief executive Dr Charmaine Griffiths said: “Charities have driven significant breakthroughs which have turned the tide on some of our biggest killers, including heart disease and cancer.

But without Government commitment to a Life Sciences-Charity Partnership Fund, charities will be forced to make devastating cuts to their research which will be hugely damaging for patients and UK science.” www.ippr.org www.bhf.org.uk

TALKBACK COVID UPDATE 11

Image: rawpixel.com/freepik

desire to change parts of their life and routine once the pandemic is over.

“This is likely down to the upheaval of lockdown breaking many habits and leading to people reassessing what they feel is important or worthwhile, be that spending time with

their family, supporting their community, or saving money, to name some of the more popular responses.”

Groups least likely to report that they would make changes to their lives were those who lived alone, those on lower household incomes, and those without children. Those aged 60+ were most likely to say they would return to living exactly as they had before, with 16% saying they would, versus just 7% of the population under 60.

Cheryl Lloyd, Education Programme Head at the Nuffield Foundation, said: “While many respondents say they would make lifestyle changes after the pandemic, this is less likely to be the case among people from lower income households. This prompts important questions about whether lifestyle changes feel less feasible for people with lower household incomes who are, for example, more likely to be in precarious employment and have less disposable income. To be effective, policies should be targeted and designed in consultation with at-risk groups, to ensure they do not exacerbate existing health and social inequalities.” www.ucl.ac.uk/epidemiologyhealth-care

research investment The loss of funding will impact on new medical discoveries and treatments

Image: pressfoto/freepik

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people’s priorities

Online platform to support physical and emotional recovery from Covid-19 A NEW NHS digital platform has been launched to help health professionals support people who are recovering from Covid-19 at home.

“Your Covid Recovery” has two key components: a public site with general information on all aspects of recovering from Covid-19 including physical, emotional and psychological wellbeing; and an interactive rehabilitation platform specifically for patients with post-Covid syndrome, which requires referral and face-to-face assessment from a healthcare professional.

Patients who are referred to the resource will receive advice, support and face-to-face assessments from a healthcare professional, to help them recover in the short and immediate term after having Covid-19. It is intended as an adjunct rather than a replacement for usual primary care support and rehabilitation services, and – as Covid rehab – is funded as additional unmet need and funds are not taken from already underinvested areas of rehab.

The Chartered Society of Physiotherapy (CSP) has been involved in developing and reviewing the online platform. Chief executive Karen Middleton said: “It could help thousands of people to chart and self-manage their conditions at home. However, we must keep in mind that while virtual rehab will work very well for a lot of people, it won’t for everyone and it’s essential that no-one falls through the gaps.

“We must also not forget the huge, unmet rehabilitation needs of non-Covid patients coping with a variety of longterm conditions and we must tackle the health inequalities that Covid-19 has laid bare.”

CSP members are being encouraged to inform their patients about the platform and raise awareness of the new resource, so that people across the UK have access to this rehabilitation support. www.england.nhs.uk www.csp.org.uk

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12 TALKBACK RESEARCH

Credit: Image: Freepik

Falls prevention programmes are ineffective in preventing fractures, study finds TWO “screen and treat” programmes to prevent older people falling do not reduce fractures, an NIHR-funded trial has revealed.

As part of the largest clinical trial of its kind in the UK, researchers from the University of Warwick and University of Exeter examined two approaches to preventing falls in older people to find out if they also resulted in fewer fractures. Their results, published in the New England Journal of Medicine, showed that these programmes are ineffective, when using a population screening approach, in reducing fractures in older people.

The study examined two programmes: multi-factorial fall prevention (MFFP), and exercise for people at increased falls risk.

People living in the community (not in care homes) were screened for falls risk and invited to attend the programmes. Both interventions are widely used in health services internationally and prescribed regularly for older people.

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Multi-factorial fall prevention involved a one-hour assessment with a trained health professional for eight risk factors for falls.

Following this, participants would either be given specific advice, see their GP for a detailed medication review, or be referred for physiotherapy-led exercise. The exercise programme ran for six months during which they were seen by a physiotherapist and exercised at home.

Staying mobile

Lead author Professor Sallie Lamb of the University of Exeter, who began the research while working at the University of Warwick, said: “While this is a disappointing result, it shows that we must continue to invest in research and development to reduce fractures in older people. We need to think about the broader causes of fractures, and understand more about what happens to cause falls.”

Co-author Professor Julie Bruce from Warwick Clinical Trials Unit at the University of Warwick said: “We saw benefits to the general health of people doing exercise and a short-term reduction in the number of falls after exercise. People completing the six-month exercise programme became stronger and their balance improved – but that did not translate into a reduction in fractures in the long term. The take home message is that we would encourage older people to do physical activity and keep mobile because of the health benefits.”

Each year, up to one in 20 older people with a history of falling sustains a fracture, with some being admitted to hospital, or needing to move to a care home. One in three people with a hip fracture dies within one year. Hip fractures alone cost the UK more than £2 billion a year. www.nihr.ac.uk www.nejm.org

TALKBACK RESEARCH 13

PATIENTS with suspected early inflammatory arthritis are waiting too long to see a specialist, says a new report.

The National Early Inflammatory Arthritis Audit, conducted by the British Society for Rheumatology (BSR), reveals that only 41% of patients met the three-day standard for referral from their GP and only 38% referred to a rheumatology unit were seen within the three-week guidelines. The average wait for the first appointment was 28 days.

A prompt diagnosis of early inflammatory arthritis can make the difference between developing life-long disabilities or actually going into remission.

Shortages of rheumatology staff was identified as a key factor for the delays. The audit data also shows considerable variation

Image: Pressfoto

Early inflammatory arthritis patients ‘wait too long’ to see specialist

Prompt diagnosis can be life changing across England and Wales and identifies 51 trusts or health boards performing less well than the rest. These “outliers” are being encouraged to use their data to lobby for additional resources as well as to look at how processes can be improved.

Ali Rivett, Chief Executive of the BSR,

said: “Our audit plays a vital role in identifying where the problems are. It’s not just about resources but also units making better use of the resources they have.

Reconfiguring services and sharing learning among units can make a real difference.”

The audit helps to show the impact of early inflammatory arthritis on people’s lives and the importance of prompt treatment; patients who accessed appropriate treatment within three months were much more likely to get back to work and less likely to be depressed and anxious.

It shows good examples across England and Wales where units are performing well, and regional champions have been set up to help others learn from their good practice. www.rheumatology.org.uk/neia-audit

KEYHOLE surgery is no better at treating frozen shoulder than less invasive therapies, an NIHRfunded trial published in The Lancet has found.

Frozen shoulder is a common and painful condition in which movements in the shoulder become restricted. It affects 10% of women and 8% of men of working age and can last years.

A common surgical treatment is arthroscopic capsular release (ACR), a keyhole procedure under general anaesthetic where a probe is inserted into the shoulder, along with a camera and the joint capsule is released, stretched and manipulated to regain a range of movement.

However, NIHR researchers, led by a team at South Tees Hospitals NHS Foundation Trust and University of York Trials Unit, have found that ACR was no more effective than two other less costly and invasive treatments using a patient-reported questionnaire about shoulder pain and function.

One treatment was manipulation under anaesthesia (MUA) – a minimally invasive procedure where surgeons move the shoulder joint to a full range of motion. The other was early structured physiotherapy (ESP) with a steroid injection – a treatment specially designed for the trial that doesn’t require a general anaesthetic.

Chief Investigator Professor Amar Rangan,

Consultant Orthopaedic Surgeon at South Tees NHSFT, said: “Frozen shoulder is a common condition for which thousands of people each year need hospital treatment because of the pain they are in and struggle with daily activities, sleep and work.

“Our trial has shown that an expensive keyhole surgery is no better than two alternative therapies. This could provide more choice for patients – especially those with conditions like diabetes who have to manage a chronic disease and who may not want the additional inconvenience and risk of surgery under anaesthetic.”

The randomised controlled trial was carried out in 35 UK hospitals, where 503 patients were randomised, with 203 receiving ACR and 201 MUA. The remaining 99 underwent ESP. All three treatments led to significant improvements in patient reported shoulder pain and function over one year, but none of the treatments was superior.

Overall, MUA was found to be the most costeffective option that provided the NHS with the best value for money spent in terms of health gains for the patient. www.nihr.ac.uk

Image: Freepik

Keyhole surgery no better than other therapies for frozen shoulder

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14 TALKBACK MANAGEMENT

Managing your MSK conditions while waiting for treatments TWO periods of national lockdown have seen people working from makeshift home offices and being less active, with many afraid to use NHS services.

The ability to bounce back and resume “normal” health services – especially routine surgery and procedures – has been problematical. Following the spring lockdown, MSK services returned far too slowly according to the Arthritis and Musculoskeletal Alliance (ARMA)1, who have warned about the impact on individual health and recovery of the economy.

ARMA chief executive Sue Brown said: “Looking at the proportion of normal elective care provided in August by speciality, orthopaedics and rheumatology both fall in

the bottom four specialities. This is not acceptable.

“Waiting in pain impacts people’s physical and mental health and ability to work.

Delays in accessing treatment such as joint replacement surgery can have long-term serious impacts on health.”

Learning from experience

Now, as we emerge from a second lockdown, it is hoped the lessons have been learned. ARMA, along with other stakeholders, has worked with NHS England to listen to the experience of people living with MSK conditions and identify

Image: katemangostar

Patient member organisations are providing peer support

innovations which may help through the coming months. These are being published on the NHS Change Challenge website2.

While not a replacement for NHS services, ARMA’s patient member organisations are providing vital additional support including advice, information, peer support, online groups and networks. It is important to ensure patients know these resources exist.

The MSK Lived Experience Group has collated intelligence from a range of sources to find out the impact on people living with MSK conditions and produced a report of the themes that emerged. National Voices3 has also produced a report: “What We Need Now”. This examines what matters to people for health and care, during Covid-19 and beyond, and includes recommendations for system leaders and those designing and delivering services.

People who are waiting can do things to support themselves and there are resources that can help. The Chartered Society of Physiotherapy webpage4 signposts people to online resources.

Sue Brown adds: “People most want to know what is happening. They want to know how long they might be waiting, what they can do while they wait, and they want to be reassured that they are not forgotten.

If people are offered treatment, they also need to have the measures that will be taken to keep them safe explained.”

1) www.arma.uk.net 2) https://nhschangechallenge.crowdicity.com 3) www.nationalvoices.org.uk 4) www.csp.org.uk/conditions/managing-pain-home

New MSK care pathway for diagnostic clinicians FOLLOWING the introduction of first contact MSK physiotherapy roles in primary care, a new career pathway with an educational training “road map” has been launched by Health Education England (HEE).

The scheme sets out a route into MSK primary care roles for first contact practitioners and advanced practitioners. All clinicians completing the required training via a portfolio or a taught route will be recognised and held on a directory of practitioners at the HEE Centre for Advancing Practice.

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In a blog to launch the roadmap, Amanda Hensman-Crook, an HEE AHP national clinical fellow, said: “For the first time, physiotherapy undergraduates will be able to see primary care as a career choice and a developmental journey from the day they register with the HCPC. “This is a great opportunity for structured CPD and to have recognition of meeting the new standard of practice in primary care.”

HEE has stipulated that, from April 2022, all clinicians must have completed the

required training prospectively and retrospectively before taking up primary care roles.

To work in primary care means working with complexity, uncertainty, co-morbidity, polypharmacy, frailty, public health, mental health, long-term conditions and safeguarding. All of which inform an MSK assessment and form a diagnosis and management plan for the patient. www.hee.nhs.uk www.csp.org.uk

TALKBACK MANAGEMENT 15

Osteopaths should be used to help high demand for MSK care, says report EARLY involvement of osteopaths within NHS MSK services could significantly improve service delivery and patient care, says a new report1.

An independent panel of healthcare professionals, chaired by Professor Adrian Newland, has authored the report on the role of osteopaths as Allied Health Professionals within the NHS, and

their potential to provide much needed additional capacity to the delivery of NHS MSK services to improve patient care.

The panel investigated examples of where osteopaths work within the NHS, their contribution to multidisciplinary teams and impact on patient care, and the barriers and challenges on the ability to increase integration of the profession within the NHS. Commenting on the findings, Maurice Cheng, chief executive of the Institute of Osteopathy, said: “The NHS Long Term

Plan recognised the need to move to a new service model in which patients get more options, better support and properly joined-up care at the right time in the optimal care setting. These ambitions were also echoed within the recently published NHS People Plan, calling for the health service to make effective use of the full range of our people’s skills and experience to deliver the best possible patient care.

“Osteopaths are particularly well-placed to support these ambitions and provide the capacity and expertise to help support the delivery of patient care and outcomes.

At this current time, when the demand on MSK care is exceptionally high, we are calling for osteopaths to be used more widely to provide early assessment and intervention for patients.”

1) The role of osteopaths as allied health professionals within the NHS www.iosteopathy.org

Osteopaths to respond to CPD evaluation survey THE General Osteopathic Council’s annual (CPD) evaluation survey is now open, presenting a chance for osteopaths to provide feedback on the practice – including the impact of COVID-19 – and to discuss the future resource needs.

Last year’s survey received over 450 responses, which helped the GOC to develop tools to meet new challenges faced by the profession.

The survey will run until 31 January 2021. www.osteopathy.org.uk

Properly joined-up care at the right time should be available to patients

Image: Pressfoto

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16 TALKBACK DIAGNOSIS AND TREATMENT

Delayed diagnosis of axial spondyloarthritis can ruin lives Ministers are being urged to support measures to end the 8.5-year delay to diagnosis for people with inflammatory arthritis.

If left untreated, axial SpA can result in significant health issues such as spinal fusion

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HEALTH ministers are being urged to support measures that can radically improve the lives of people with axial spondyloarthritis (axial SpA), a painful and progressive form of inflammatory arthritis.

Currently, the average delay to diagnosis for this condition is 8.5 years. The National Axial Spondyloarthritis Society (NASS) is working to see the diagnosis delay reduced to just 12 months.

Around 1 in 200 adults in the UK live with axial SpA. The condition affects young people, with symptoms often starting in their early teens. If left untreated, it can result in significant health issues such as spinal fusion, as well as damage to joints ligaments, tendons and mental health.

NASS proposes concrete steps that would enable thousands of people who are yet to be diagnosed with the condition to get the right care faster: l increase public awareness of axial SpA with a

campaign backed by public health bodies so that people consult a GP or primary care professional as soon as they notice symptoms l provide Clinical Commissioning Groups with a clear and simple inflammatory back pain pathway to ensure swift referrals directly to rheumatology and encourage increased awareness of the condition among GPs and other primary care professionals.

Dr Dale Webb, Chief Executive of NASS, said: “Far too many young people wait years for a diagnosis and treatment. This inhibits normal life and risks permanent disabilities. Faster diagnosis, with the right pathways to care, would transform lives and save the economy money.

“The Government needs to act now so that the public know about the condition and can seek medical advice at the earliest opportunity and to ensure that primary care professionals identify and refer patients quickly to rheumatology for diagnosis.

No-one should be locked out of life because of a delay in getting a diagnosis.”

Paul Curry, who lives with axial SpA, said: “I waited for more than 10 years to be diagnosed with axial SpA. While I waited, my spine fused and I gave up any hope of a career in professional sport. When I received a diagnosis, at last I knew the pain was out of my control and could be treated.”

Image: jcomp/freepik

Exercise is the best way to help yourself Regular exercise is the single most important thing you can do to help yourself. The more flexible you are the easier it is to do everyday tasks, and the more mobility you have the easier it is to do things. Exercise can result in less stiffness and pain at night and improve sleep quality.

The focus for exercise for people with axial SpA is on improving or maintaining: l r ange of movement in the joints l posture control l muscle strength l muscle length l lung capacity l balance lc ardiovascular fitness.

Whipps Cross University Hospital’s Early Inflammatory Back Pain Service, run by Barts Health NHS Trust, has produced a video of specific exercises to help you maintain and improve flexibility and strength. https://nass.co.uk www. whippscrossrheumatology. co.uk

TALKBACK DIAGNOSIS AND TREATMENT 17

Image: wayhomestudio/freepik

Deciding on the best approach for diagnosing and managing ME Much of the distress is due to the difficulties in recognising, acknowledging and accepting the condition

NICE has published its draft updated guideline on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

The draft guideline recognises that ME/CFS, which is estimated to affect more than 250,000 people in England and Wales, is a complex, multi-system, chronic medical condition where there is no “one size fits all” approach to managing symptoms. It stresses the need for a tailored, individualised approach to care that allows joint decision making and informed choice.

Because of the harms reported by people with ME/CFS, as well as the committee’s own experience of the effects when people exceed their energy limits, the draft guideline says that any programme based on fixed incremental increases in physical activity or exercise, for example graded exercise therapy (GET) should not be offered for the treatment of ME/CFS.

Energy envelope

Instead, it highlights the importance of ensuring that people remain in their “energy envelope” when undertaking activity of any kind and recommends that a physical activity programme, in particular, should only be considered for people with ME/CFS in specific circumstances.

The draft guideline also emphasises that

Exercise is not a treatment or cure for ME/CFS cognitive behavioural therapy (CBT) is not a treatment or cure for ME/CFS. However, as a supportive therapy which aims to improve wellbeing and quality of life, the draft guideline says CBT may be useful in supporting people who live with ME/CFS to manage their symptoms.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “ME/CFS can cause profound, long-term illness and disability, and much of the distress surrounding it is caused by difficulties in recognising, acknowledging and accepting the condition and its impact. This has been compounded further by a lack of effective treatments, wide variation in access to services, and by controversy over the use of graded exercise therapy and CBT that has served only to alienate many people with ME/CFS and, in some cases, undermine the confidence of those caring for them.

“The recommendations in this draft guideline have been developed by an independent committee that was guided not just by the clinical evidence, but also by the experience and testimony of people with ME/CFS.”

Adam Lowe, a lay member of the guideline committee, said:“ME/CFS patients have been voicing their concerns about graded exercise therapy for a long time, and the evidence presented to the committee supported these concerns.

“One of the key points in the draft guideline is that exercise is not a treatment or cure for ME/CFS and should not be presumed to be safe for those with this disabling and often neglected illness. The approach it recommends is a pragmatic one which allows patients to self-manage themselves, within their daily limits, while using readily available interventions to address the most serious of their symptoms first.”

Specialist team

The draft guideline recommends reducing the time from four months to three months that a person needs to have persistent symptoms before a diagnosis of ME/CFS can be confirmed. It says that people should then be directed to a specialist team (in the case of children this should be a paediatric specialist team) experienced in the management of ME/CFS to confirm their diagnosis and develop a personalised management plan. This will enable people to access care earlier and could potentially improve longer-term outcomes. www.nice.org.uk

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18 TALKBACK WORKPLACE

Workplace MSDs: health monitoring The HSE’s body mapping tool asks about musculoskeletal disorders, such as aches or pains, you may have had recently.

HEALTH monitoring can help reduce MSDs in the workplace. In law, you do not have to do this, but it is often useful to collect this information so that you are aware of any health issues your workers have and to monitor trends. For example, it can prove helpful when you introduce a new task or change an existing process. It also helps to check any controls you put in place are preventing problems starting or getting worse.

You may need to take advice, for example from an occupational health provider, about setting up and managing your health monitoring system. They will recommend consulting workers so that the benefits are understood and to be clear about what should be done.

Set up a simple reporting method so the information goes to the person who will take action. You could consider using a body map to help individuals or groups pinpoint where their symptoms are. Review sickness absence records/fit notes and any occupational health advice; investigate any clusters of problems or changes in reporting rates you find; and ask workers if their work caused the problem or makes it worse and to identify those tasks.

The results of your health monitoring can help you look at whether your risk management system for MSDs is working, whether the actions you have taken have been effective and that risks have been reduced to as low as reasonably practicable, and whether the findings suggest a need for new control measures.

The following tips may help reduce your back pain and speed up your recovery, says the NHS: l stay as active as possible and try to continue your daily activities – this is one of the most important things you can do, as resting for long periods is likely to make the pain worse l try exercises and stretches for back pain; other activities such as walking, swimming, yoga and pilates may also be helpful l take anti-inflammatory painkillers, such as ibuprofen – remember to check the medicine is safe for you to take and ask a pharmacist if you’re not sure l use hot or cold compression packs for short-term relief – you can buy these from a pharmacy – or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well.

It also helps if you stay optimistic and recognise that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.

If the pain is severe or gets worse over time, it is advisable to see a doctor or other healthcare professional. www.nhs.uk

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Image: yanalya/freepik

Tips that might relieve your back pain

TALKBACK WORKPLACE 19

can help

Providing support for workers PEOPLE with MSDs usually recover completely if the problem is spotted early and treated appropriately, says the HSE. But there is an increased risk of their problem coming back, even if the symptoms have gone. As well as health monitoring, there are other things you can do to manage these conditions.

Manage sickness absence and return to work, for example by making adjustments to the way they work. If the person has been off work, they may be able to return before all their symptoms have completely cleared up, as long as this is not against medical advice. Occupational health providers can support your workers and help you manage musculoskeletal disorders. They can: l assess symptoms and may diagnose a

specific condition l ask about work tasks to try and identify anything contributing to the problem l provide fitness-to-work advice, including any restrictions needed l provide treatment recommendations, such as physiotherapy l visit the workplace to provide further advice l help to review risk assessments and workplace controls.

Consider each person on a case-by-case basis. It may be necessary to change a worker’s duties if a task is causing an MSD or making it worse. They may need to stop doing some tasks temporarily to help them recover. Sometimes, they may not be able to return to a particular task. www.hse.gov.uk

IT IS estimated that more than 100 million European citizens, many of whom are young and working age, currently suffer with rheumatic and musculoskeletal diseases (RMDs). They are the main occupational disease, accounting for around 60% of all health problems in the workplace and are a major cause of sick leave and premature retirement.

The pandemic has compounded the challenges faced by this vulnerable group in different ways. Some have greater vulnerability to Covid-19 due to being treated with immunosuppressants and steroids or have a common co-morbidity, such as cardiovascular disease, that signify higher risk. RMD sufferers have also been affected by reduced access to medication, or the reprioritisation of healthcare facilities away from people with chronic conditions.

Job access and security is also a highly significant concern as RMD sufferers may face potential workplace absenteeism during a global downturn.

The European League Against Rheumatism (EULAR) believes it is vital that the EU member states address the hidden costs of workplace exclusion for people suffering one of the many diseases under the RMD umbrella.

Speaking during a recent online panel discussion, Professor Iain McInnes, EULAR President, said: “For many people living with RMDs, job insecurity and unemployment are a daily reality that much of the rest of society only experiences in times of crisis.

“The pandemic has created new workplace barriers for Europeans with RMDs, but it has also highlighted the opportunities flexible working patterns and digital workplace and healthcare solutions can offer this community.”

Image: rawpixel.com/freepik

Exclusion of workers with RMDs ‘will have huge economic impact across Europe’

The exclusion of RMD patients from the workplace costs Europe an estimated €163bn a year. The short-term impact of the Covid-19 pandemic, with the longer-term trend of an ageing European population, are expected to dramatically increase this impact without urgent action.

EULAR says Europe needs policies and programmes that create an open, positive and supportive culture between patients, colleagues, and employers, including strong protection against workplace discrimination. It also needs to create ergonomic workplaces to increase comfort and reduce risk of accidents and flares, as well as to promote flexible work schedules and tele-working. www.eular.org

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20 TALKBACK STANDARDS AND STATISTICS

Measuring the prevalence of health The latest figures showing the recorded prevalence of 21 conditions, from hypertension to osteoporosis and rheumatoid arthritis have been published

by NHS Digital.

THE prevalence data is collated in the Quality and Outcomes Framework (QOF)1. It has been collected from 96.2% of general practices in England and can be broken down to regional and general practice level. It identifies how the recorded incidence of these conditions has changed since the previous year.

Conditions are grouped into categories: cardiovascular; respiratory; lifestyle; highdependency and other long-term conditions; mental health and neurology; musculoskeletal; fertility, obstetrics and gynaecology; and quality improvement.

The prevalence of some conditions is measured as a proportion of the total number of people registered at a surgery, whereas others are age specific. The publication also provides information on the activity of GPs in relation to 26 measures overall – this is expressed as achievement.

Measures, called indicators, are agreed as part of the GP contract negotiations every year. These indicators have points attached that are given to GP practices based on how they are doing against these measures. You can see how a GP practice has performed against the measures.

Stress in nursing at ‘alarmingly high’ levels, says report FOLLOWING the recent focus on the incidence of back pain in nursing (TalkBack autumn), a new report raises concerns about the high rates of stress and burnout in the profession.

The report, The Courage of Compassion, produced by the King’s Fund for the RCN Foundation, states that staff stress, absenteeism and turnover in the professions have reached alarmingly high levels, and this has been compounded by the COVID-19 pandemic.

It calls for new minimum standards to improve working conditions and a review of 12-hour shifts to address exhaustion and burnout among nurses and midwives.

Susan Masters, RCN Director of Nursing, Policy and Public Affairs, said: “Today, there are approximately 50,000 registered nurse vacancies in the NHS in the UK, impacting patient safety, and morale and wellbeing in the profession at a time when these are crucial.

“At present, really ambitious and well-qualified young people are struggling with gruelling shifts, staff shortages and poor pay. They feel they have no choice but to leave a career they should love – at a huge cost to patient care. Politicians and officials need to grasp the nettle before we lose even more.”

The report sets out eight key recommendations to support the wellbeing of nurses and midwives across the UK, including those working in adult social care, GP practices, community care and other settings.

Among the recommendations is an urgent call for a review of how 12-hour shifts affect staff mental health and wellbeing and patient safety. Although some staff prefer them as they allow for more flexible working patterns, evidence shows that 12-hour shifts are associated with poor sleep and wellbeing among staff and lower quality of care for patients.

Susan Masters added: “While we understand that some of our members prefer 12-hour shifts, such as those with caring responsibilities or long commutes, we also recognise the challenges these shifts can bring. We would welcome a full review of them, and their impact on nursing staff and patient care.

“Where 12-hour shifts are used, employers should offer appropriate support with respect to staff health and wellbeing, including adequate rest breaks, careful rostering and internal rotations.”

Other recommendations in the report include suggestions to improve working conditions, shift patterns, workplace culture, team-working, support for new staff, supervision and learning opportunities. www.kingsfund.org.uk www.rcn.org.uk

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Image: drobotdean/freepik

TALKBACK STANDARDS AND STATISTICS 21

conditions across GP practices You can find out how common certain conditions are in your area and, for example, compare this against the national average.

Some 6,720 practices were included in the 2019-20 Quality and Outcomes Framework.

The highest recorded prevalence rates were for hypertension (14.1%), depression (11.6%) and obesity (10.5%). The greatest change in QOF prevalence was for depression (0.8 percentage points higher than in the previous year). https://digital.nhs.uk

Set measures are agreed as part of the GP contract negotiations every year

1) Quality and Outcomes Framework (QOF) – Prevalence, Achievements and Personalised Care Adjustments Report, England 2019-20

Image: racool_ studio/freepik

Headaches – a new quality standard for chiropractors HEADACHES are one of the most common health complaints, with most people experiencing them at some point in their life.

The Royal College of Chiropractors’ Health Policy Unit has published a new quality standard which covers the chiropractic assessment and management of adult patients presenting with headache.

Chiropractors regularly see patients that present with headache, often having not been seen by any other healthcare professional, and with no diagnosis having been made. Chiropractors have the skills and competencies to assess patients in order to diagnose most primary headaches, identify secondary headaches that require further investigation and, importantly, recognise the red flags that indicate a medical emergency.

As well as having a role in the management of some primary headaches and a few secondary headaches (in particular cervicogenic headaches), chiropractors also play an important public health role in providing support and advice to patients, signposting and making appropriate referrals.

There are a wide range of different patient presentations associated with headache and the management in each case will be different, requiring an individualised approach. The quality statements that comprise the new Headaches Quality Standard are therefore general but, nevertheless, provide aspirational but achievable markers of high-quality, cost effective patient care.

Incidence of headaches

Image: kjpargeter/freepik

Given the chronic nature of many headaches, where appropriate, the Headaches Quality Standard should be read in conjunction with the chiropractic quality standards on “Chronic Pain” and “Supportive Self-Management in Chronic Care”, both also published by the RCC.

In the UK, migraine headache occurs in 15% of the adult population, with around 200,000 individual episodes estimated every day, resulting in high levels of disability and work absence, as well as having a significant impact on the wider economy.

Episodic tension-type headaches affect 80% of people at some time and are chronic (having more days with a headache than without one) in up to 3% of the population. Medication overuse headache is the third most common cause of headache, affecting up to 2% of adults.

Despite these figures, headache is under-estimated, underdiagnosed and under-treated, and remains a major public health concern. https://rcc-uk.org/

● MSK conditions: Chronic Low Back Pain, Acute Low Back Pain, Acute Neck Pain, and Osteoporosis are other quality standards published by the Royal College of Chiropractors.

These can be downloaded from the website.

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22 TALKBACK DESIGN AND TECHNOLOGY

New monitoring device to track posture of sedentary workers Image: yanalya/freepik

IMPERIAL College London is working on a new project that aims to develop a monitoring device to track daily posture and body activity of people suffering from back pain, mainly while working in front of a computer.

In the UK, almost half of employed adults are working from home because of the recent pandemic. This means that a surge is expected in the number of people suffering from back pain due to long hours sitting at their desks and to incorrect posture. The current number is already staggering: 540 million people around the world suffer from lower back pain at any one time, making back pain the largest single-cause of disability world-wide.

Feedback

Claire is a smart lifestyle-based support to allow people to prevent and self-manage back pain, empowering and providing them with control over their own wellbeing. It achieves it with an AI-powered platform based on contactless monitoring of body activity and sitting posture and on real-time feedback.

The proposed smart system will use contactless monitoring with radar technology to track posture and body activity, with no need to wear any devices, while respecting the user’s privacy.

Moreover, a real-time feedback will notify the user through an app when slouching on the seat or when they need to stand up straight and move/take a break. Finally,

a personalised AI-powered assistant will interpret and learn over time from sitting and movement habits and tailor the advice accordingly.

Dorian Haci, a researcher in medical technologies at Imperial College London said: “By combining novel sensing technologies with an intelligent platform, we believe we can provide people suffering from back pain with smart tools

helping them to prevent and self-manage their pain, nudging towards a healthier lifestyle.”

The team would like to speak to TalkBack readers currently suffering from back pain or who have suffered in the past and understand what their daily activity looks like and what they currently use to prevent and manage their pain. Contact: d.haci14@imperial.ac.uk

Image: peoplecreations/freepik

Methods to evaluate technology NICE has launched a public consultation on proposals for changes to the methods it uses to develop guidance on medicines, medical devices and diagnostics.

The potential changes are part of the largest review ever carried out into the

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methods and processes NICE uses to produce its guidance on health technologies.

Meindert Boysen, deputy chief executive and director of the Centre for Health Technology Evaluation at NICE, said: “As we develop

Talkback Advertising

TALKBACK DESIGN AND TECHNOLOGY 23

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Image: senivpetro/freepik

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  Sections Sections specially specially targeted targeted to BackCare to BackCare Professionals Professionals and and therapists therapists   Readers Readers Letters Letters   BackCare BackCare branch branch news news and and events events musculoskeletal risks for “RISK-reduction through design”   Back Back product product testing testing and and the the latest latest gadgets gadgets Talkback is quarterly, issues every year.

– especially examples is an award that aims to inspirei.e. 4 workers that have made a real impact. businesses to consider how Issue 1 – Spring Edition Published in March Issues Issues and and Dates Dates Design solutions that have ergonomics-based design th (Advertising deadline 15 of February) reduced musculoskeletal risks to changes can reduce the risks Talkback Talkback is quarterly, is quarterly, i.e. i.e.

4 issues 4 issues every every year. year. large numbers of workers will be of work-related musculoskeletal Issue 2 – Summer Edition Published in June attractive, but the organisers are disorders (MSDs). thEdition Issue Issue 1 –1Spring – Spring Edition - Published - Published in March in March (Advertising deadline 15 of May) th th also looking for novel, innovative Each year, it(Advertising is (Advertising sponsoreddeadline by deadline 1515of February) of February) or niche solutions. In-house or the Health and Safety Executive Issue 3 – Autumn Edition - Published in September consultant-led design changes (HSE) and the Issue Chartered Issue 2 –2Summer – Summer Edition Edition - Published - Published in June in June This is (Advertising a special bumper edition th thin line with the theme (Advertising deadline deadline 15 15 of May) of May) are eligible for the awards, Institute of Ergonomics and of BackCare Awareness Week campaign for the year Human Factors (CIEHF) to th though the businesses should (Advertising deadline 15Edition of August) Issue Issue 3 –3Autumn – Autumn - Published - Published in September in September make the nominations (not the reinforce the message that risks Edition This This is aisspecial a special bumper bumper edition edition in line in line with with thethe theme theme designers). from MSDs controlled Issuecan 4of–be Winter Edition - Published incampaign December BackCare of BackCare Awareness Awareness Week Week campaign forfor thethe year year th th th Nominations for the 2020-21 and that employers should (Advertising (Advertising deadline deadline 15November) 15 of August) of August) (Advertising deadline 15 of award should describe the task, eliminate or reduce these risks Issue Issue 4 – 4 Winter – Winter Edition Edition - Published -setting Published in December in December work and the MSD issue at source where possible. th th (Advertising (Advertising deadline deadline 15 15 of November) of November) you were trying to solve before Submissions are now open the design changes.

Include for the 2020-21 award. You can photograph(s) to illustrate nominate any design solution your main points. Send your implemented in workplaces in nomination to: MSDPP@hse. the UK that have demonstrated gov.uk by 31 January 2021. how you have reduced

– NICE presents a case for change a new regulatory and access environment for medicines, medical devices, diagnostics and digital health technologies, our methods should be aimed at supporting early patient access at a reasonable cost to the NHS, for example by encouraging companies to

launch their products in the UK first.

“Ensuring that our methods are clear, transparent and predictable should allow us to speed up evaluation processes for new and emerging technologies.” www.nice.org.uk

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