Is establishing a specialist back pain assessment and management service in primary care a safe and effective model? Twelve-month results from the Back pain Assessment Clinic (BAC) prospective cohort pilot study

Mr Adam de Gruchy1

1Royal Melbourne Hospital, Parkville, Australia


To report on the design, implementation and evaluation of the safety and effectiveness of the BAC model.


The BAC is a community-based specialist service for assessing and managing neck and low back pain (LBP), staffed by Rheumatologist and Advanced Practice Physiotherapists. The BAC pilot was evaluated using the Victorian Innovation Reform Impact Assessment Framework (VIRIAF). Data were obtained by auditing BAC activity and conducting surveys and interviews of patients, stakeholders and referrers.

Main outcome measures: (1) access to care; (2) appropriate/safe care; (3) workforce optimisation and integration; and (4) efficiency and sustainability.

Results: A total of 400-500 patients are seen annually. Most were referred to hospital services by general practitioners (87%) for LBP (63%) and neck pain (24%). All patients were seen within 10 weeks of referral and commenced community-based allied health intervention within 2–4 weeks of BAC assessment. Of patients seen, 34% had medications adjusted, 57% referred for physiotherapy, 3.2% to pain services, 1.1% to rheumatology and 1.8% surgical review. Less MRI scans were ordered in BAC (6.4%) compared with  spinal surgical clinics (89.8%), which translated to a cost-saving of $52 560 annually. Patient and staff satisfaction was high. There have been no complaints or adverse incidents. Waits to access spinal surgical clinics has reduced from a average of 18 months to 3 months since implementation of the BAC. Surgical conversation rates currently are 63% compared with historical state averages of 10%.

Conclusion Evaluation of the BAC pilot suggests it is a potentially safe and cost-saving alternative model of care for the assessment and management of neck and back pain, that has positive effects on spinal surgical clinic access and surgical conversion rates.


Adam de Gruchy has over 20 years experience as a physiotherapist and is currently employed at the Royal Melbourne Hospital as an Advanced Practice Physiotherapist and service manager of the Back pain Assessment Clinic (BAC). He is also affiliated with University of Melbourne and La Trobe University.

He has implemented and maintained Advanced Practice services in the UK and Australia, covering orthopaedic, neurosurgery, rheumatology and primary care musculoskeletal health settings.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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