Grant: Pro. Gr. - PA: Inst. of Musculoskeletal Health and Arthritis: IMHA Mandate Areas

Low back pain (LBP) is a massive problem in Canada that causes a great deal of pain, disability, cost and even premature death. The good news is that solutions for chronic LBP are available. Many guidelines now recommend education and exercise as the best intervention for LBP. Unfortunately, education and exercise programs are not funded in Canada - only Canadians with extended health benefits can access these programs. As a result, more than 50% of Canadians experiencing LBP who do not have extended health benefits have no alternative but to seek free care from their physicians, who in turn, have little choice but to reach for what they have available including opioids, x-rays and referrals to specialists. Not only are these interventions unhelpful for chronic LBP, they are often harmful, sometimes deadly and disproportionately affect lower socio-economic status households. We have found a solution to this problem by providing primary care physicians and their patients with funded access to an internationally recognized education and exercise program (GLA:D Back) - the type of intervention most often recommended by global guidelines for chronic low back pain. Providing no-cost access to this program is possible by leveraging a solution hiding in plain sight: training salaried workers in primary health care settings (e.g. exercise specialists, nurses) to provide GLA:D Back. In this application, we will describe how we have used this approach in seven primary care networks to date and how we intend to scale, spread and sustain this program into other primary care settings. With this work, all Canadians, including chronically disadvantaged populations, can receive high-value LBP care, which will improve patient outcomes, doctor satisfaction, and healthcare costs.