This short blog introduces a novel infographic for use by physiotherapists who treat low back pain.
The Art of translating knowledge in health care
There is an ongoing, often ignored role for visual images in the translation of health care knowledge. Today, we're going to talk about an important research document relating to the management of perhaps the most common complaint we see in private practice. It's called the TOP Alberta Doctors Guidelines for Low Back Pain Management. (Here's where the Guild helps bring some Art in to balance the Science.)
Guidelines for low back pain management
This guideline is incredibly useful for physiotherapists in outpatient MSK practice. It's recommendations are agreed upon by a panel of experts in the fields of anesthesia, diagnostic radiology, family medicine, general practice, internal medicine, kinesiology, orthopedic surgery, pharmacy, physical medicine + rehabilitation, physiotherapy, psychology, occupational therapy, all underpinned by a massive review of the literature. It is the essence of good science.
But this 49 page detailed document, freely available online, can be hard to read, and certainly hard to put into practice. It needs a visual format, and granted, the authors do provide a 2 page summary that is practical for clinicians. But the key word is practical. It's not artful.
A few years ago here at the Physiotherapy Guild, we took this data and reorganized it into a visual format with a graphic design approach. We organized each of the recommendations into one of 5 categories, then assigned them a visual icon. Each recommendation is then placed into 1 of 6 quadrants indicating whether it applies to:
ACUTE or CHRONIC low back pain,
whether there is good evidence FOR or AGAINST it,
or if the evidence in INCONCLUSIVE.
It looks like this:
You'll see that recommendations for acute LBP are on the left, and for chronic LBP on the right. (There are also data for the prevention of LBP in the grey stripe down the centre.)
Then you'll see 5 vertical columns on both the acute (left) and the chronic (right) side, and listed along the bottom is what each column of recommendations represents: MOVEMENT, LEARNING, MEDICINE, HANDS or MACHINES.
How to use the Guidelines for Management of Low Back Pain
This visual infographic is designed to be used in the moment, for clinicians to share evidence-informed recommendations with their patients. It can be hard to convince a patient of your treatment recommendations when they may have already been indoctrinated with non-evidence informed claims by other health care professionals or worse, the online multiverse.
Referring to this graphic in the room with your patient can serve as a powerful legitimizer. It can lend credibility to your role as an evidence-informed, trusted health professional. It can help your patient understand and trust your recommendations.
For your patient who is convinced they need traction, you can point out that traction appears on the list of treatments proven to NOT work, both for acute and chronic cases.
When your patient asks if they should try acupuncture, and you are in agreement that it might be helpful, you can point out that it shows up on the list of treatments proven to be beneficial for chronic cases.
One of the most common uses of this poster is to point out to acute patients that the type of treatment that has the most number of recommendations is movement and exercise (3 of those icons show up in the "what works" quadrant in the top left.) For your patient who is hesitant to move, this visual can show them that, more than any other treatment, movement is most helpful.
Once you know the box, you can then work outside it.
Too often, patients are lead toward a low back pain treatment with low reported efficacy even though they haven't yet tried the proven effective therapies. This infographic can help point that out. At the same time though, it is our duty as clinicians to use our judgement and wisdom to come up with a reasonable plan, even for patients who have tried all the right things. In tricky cases with persistent pain in spite of adherence to treatment guidelines, it can be helpful to pull this infographic into the room, and highlight the list of therapies in the "Jury's still out" section, and work with them to identify what the next options in that category might be.
We encourage you to click and download a copy of this infographic for use in your own practice. Let us know how you find it useful.
Here are some examples of highly practical infographics. They are designed to provide an extremely accessible format for sharing information visually.
Notice the format. It's easy to remember in part because it is organized in a visually appealing way. It's not a list of stats and data.
Here's another from the British Medical Journal, with a summary of managing chronic pain:
What about other guidelines for the management of low back pain? Here's one option directed at physicians in primary care.
Here's another option, with some glaring oversimplifications (there's a lot in this algorithm that we could argue with)