Non-Pharmacological Therapy for Patients with Chronic Lower Back Pain: Implementation and Evaluation of a Quality Improvement Project Utilizing Transcutaneous Electrical Nerve Stimulation
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Date
2021-05
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The Ohio State University
Abstract
Chronic lower back pain (CLBP), a condition commonly seen in primary care, affects approximately 50 million US adults. While traditional methods of CLBP management have led to excessive opioid prescribing, non-pharmacological therapies remain a relevant option for efficacious care in this population. The purpose of this quality improvement (QI) project was to develop, implement, and evaluate an evidence-based protocol to guide the treatment of CLBP with transcutaneous electrical nerve stimulation (TENS), improving patient care and decreasing opioid prescribing within a central Ohio primary care office. A team of clinicians, including an attending physician, two nurse practitioners, and two registered nurses were surveyed regarding their perceptions, attitudes, and knowledge on the TENS utilization for CLBP using an evidence-informed, investigator-designed survey. A literature synthesis informed development of an evidence-based protocol, which was presented for implementation. At 30 days post-implementation, clinicians were re-surveyed to assess changes in perceptions, attitudes, and knowledge on TENS for CLBP. A chart audit was conducted to assess protocol adherence. Comparisons of qualitative responses from pre- and post-implementation surveys exhibited notable improvements in clinician-reported perceptions, attitudes, and knowledge of TENS for CLBP. The chart review demonstrated evidence-based practice (EBP) protocol utilization increased from <0.01% to 76.8% at 30 days post-implementation. Clinicians in this setting embraced the opportunity to improve CLBP management with EBP. This project improved EBP protocol utilization rates for TENS, and although opioid prescribing rates were not assessed during the project period, utilization of TENS prescribing in this practice shows promise in potentially reducing opioid prescribing rates.
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Keywords
Transcutaneous Electrical Nerve Stimulation, Non-pharmacological, evidence-based practice, opioid prescribing, quality improvement, chronic pain