Background Back pain is one of the commonest musculoskeletal presentation with an estimated prevalence of inflammatory back pain (IBP) of 15%. Previous study in UK has demonstrated the delay in diagnosis of IBP up to 8 years. This is partly due to lack of understanding of management of IBP among the primary and secondary care physicians. Focused training on IBP could help early diagnosis and target treatment more effectively. It is therefore imperative for medical registrars to acquire adequate knowledge in management of IBP. Our previous study among GP registrars, presented in EULAR congress, demonstrated the relative lack of understanding in diagnosis and management of IBP.1 We aim to explore the perception of training in management of IBP among speciality registrars in general internal medicine (GIM).
Objectives 1) To explore the knowledge of GIM trainees in management of chronic back pain. 2) To assess the knowledge of GIM trainees in diagnosis and management of inflammatory back pain.
Methods This is an observational questionnaire based survey. The designed questionnaires were initially piloted locally, redesigned later and distributed across to all the GIM trainees including geriatrics, gastroenterology, dermatology, renal etc across the region both online and during the GIM educational study days. Data was collected and analysed using the online data manager, smart survey®.
Results Total responders were n=52 including GIM registrars from all specialities excluding rheumatology. In a typical working week about 14% of GIM registrars review 5-10 patients with chronic back pain.
We noticed that trainees are more confident in assessing MBP (64% in MBP vs 14% in IBP) particularly in eliciting adequate history (74% for MBP vs 38% of IBP). More than 90% of registrars were satisfied with their undergraduate, foundation training in MBP whereas only 13% in IBP. 34% of the respondents were satisfied with registrar training in IBP.
Seventy three % if respondents were confident in arranging appropriate investigations for MBP compared to only 14% for IBP. It is interesting to note that HLA B27 and MRI was the preferred mode of investigations as reported by the GIM trainees.
More trainees were confident in national guideline based treatment of MBP compared to IBP (70% in MBP vs 14% in IBP).There was a dearth in adequate knowledge about management of IBP with NSAIDS (52%), physiotherapy (12%) among the trainees. Only 22% of respondents were aware of guideline based treatment with TNF blockers for IBP.
Trainees wanted to review IBP patients 2 to 4 times (21%) and more than 5 times (6%) before specialist referral. Only 9% of trainees were aware of UK statistics about delay in specialist referral for AS patients. Interestingly 14% of respondents did not prefer specialist referral for IBP patients and 60% of respondents were unaware of AS speciality clinic in Leicestershire.
Conclusions This study highlighted relative lack of confidence among GIM registrars in the assessment and management of IBP. Increased awareness amongst registrars could be achieved through web based training or formal rheumatology led training sessions. Optimum knowledge in managing chronic back pain would ensure early diagnosis, institution of appropriate care, prevent physical disability and financial losses.
P Das, A Moorthy, P Wells, S Makda. Diagnosing and managing Inflammatory Back pain - How good are our GP trainees? Ann Rheum Dis 2014;73(Suppl2): 802.
Disclosure of Interest None declared