Preventing Chronic Disability from Low Back Pain - Welfare.ie

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APPENDIX A2:FORMS DESIGNED FOR USE IN PROJECTThe following 3 forms were designed to:A. assist the medical assessors in the differential diagnosis of LBPB. assess the degree, if any, of resulting disability andC. achieve and maintain consistency.A. DIAGNOSTIC TRIAGE1. SIMPLE LOW BACK PAINYESNO● 20 –55 YRS ❏ ❏● L/S region, buttocks and thighs ❏ ❏● Mechanical in nature ❏ ❏● Patient well ❏ ❏2. NERVE ROOT PAIN● Unilateral leg pain worse than low back pain ❏ ❏● Radiates generally to foot or toes ❏ ❏● Numbness & paraesthesia in same direction ❏ ❏● Nerve irritation signs – SLR restricted ❏ ❏● Nerve compression signs – motor, sensory ❏ ❏or reflex changes16
YESNO3. POTENTIAL SERIOUS SPINAL PATHOLOGY● Age: onset under 20 or over 55 years ❏ ❏● Violent trauma relative to age, e.g. fall from height ❏ ❏in young patient or heavy lift by older person withosteoporosis could indicate fractures● Constant, progressive non-mechanical pain ❏ ❏● Thoracic pain ❏ ❏● Past history – carcinoma, immune suppression ❏ ❏(from use of steroids, or HIV)● Systemically unwell, weight loss, infection ❏ ❏● Persisting severe restriction of lumbar flexion ❏ ❏● Widespread neurological signs & symptoms ❏ ❏● Structural deformity ❏ ❏3.1 INFLAMMATORY DISORDERS(Ankylosing spondylitis & related disorders)● Marked morning stiffness ❏ ❏● Persisting limitation of spinal movements ❏ ❏● Peripheral joint involvement ❏ ❏● Iritis, skin rashes (psoriasis), colitis, urethral discharge ❏ ❏● Family history ❏ ❏17
Page 1: Preventing Chronic Disabilityfrom L
Page 6 and 7: AcknowledgmentsThe author wishes to
Page 8 and 9: RENAISSANCE PROJECTPreventing Chron
Page 10 and 11: In appreciation of the facts that:a
Page 12 and 13: 7. MEDICAL ASSESSMENTSAs part of th
Page 14 and 15: 9. PROMOTING THE RENAISSANCE PROJEC
Page 16 and 17: 14APPENDICES
Page 20 and 21: 3.2 CAUDA EQUINA SYNDROMEYES NO●
Page 22 and 23: C: MEDICAL REPORT ON BACK CONDITION
Page 24 and 25: APPENDIX BGROWTH IN ILLNESS SCHEMES
Page 26 and 27: APPENDIX CSTATEMENTS FROM INTERNATI
Page 28 and 29: APPENDIX EOUTCOMES OF MEDICAL ASSES
Page 30 and 31: APPENDIX FOUTCOMES FOR APPEALS CASE
Page 32 and 33: APPENDIX GANALYSIS OF CLAIMS DURATI
Page 34 and 35: APPENDIX HOUTCOMES OF CALLS FOR ASS
Page 36 and 37: APPENDIX IESTIMATED SAVINGS FROM PR
Page 38: Table J: Comparison of outcomes of

Preventing Chronic Disability from Low Back Pain - Welfare.ie

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