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Back Skills Training (BeST) is a published, proven and highly effective method for treating low back pain. But how can we best get healthcare professionals trained in BeST, to bring its benefits to the many patients currently suffering from low back pain?


To improve the management of low back pain patients in the NHS by increasing access to a novel, proven and effective treatment called Back Skills Training (BeST). BeST uses cognitive behavioural strategies to improve physical activity and function, and reduce pain.

To optimise an accessible online learning programme that trains and supports healthcare professionals to deliver this effective new treatment (BeST) to their patients.

To identify, understand and overcome the barriers to healthcare professionals accessing and using the BeST treatment in the NHS.

Why is this important?

BeST is a new evidence-based treatment for patients with low back pain which uses cognitive-behavioural strategies (a type of therapy that focuses on how thoughts, beliefs and attitudes affect feelings and behaviour) to teach patients how to improve physical activity as well providing life-long skills to self-manage their low back pain.

Low back pain is the leading cause of disability worldwide – affecting nearly one in ten people. Low back pain can be debilitating and life-changing, reducing people's ability to work, function normally and enjoy life.

In 2009, the direct costs of low back pain to the NHS were estimated at £2.8 billion.

BeST Von Korff

Research involving over 700 patients with low back pain has shown BeST significantly reduces disability and pain compared to conventional treatments. The benefits have been shown to last up to 36 months after treatment and significantly improve patient’s quality of life and satisfaction.

BeST can be delivered to groups of patients at the same time, by a wide range of health care professionals. Making BeST not only clinically effective but also highly cost-effective. Especially compared to current recommended treatments.

Yet, to get the BeST programme into common use across the NHS would take a huge amount of time, effort and money using traditional face-to-face workshops to train healthcare professionals, such as GPs, physiotherapists and nurses.

Using BeST in routine NHS practice would require health professionals to change their behaviour and management of low back patients, which can be very challenging to do.

To overcome this, the online education package will be tailored to include proven strategies to overcome these barriers, supporting healthcare professionals to change their clinical practice and deliver this new treatment to their patients.

Delivering the BeST training online to healthcare professionals would have three main advantages:

1.    Costs would be far lower.

2.    Training would be much more accessible across the NHS.

3.    Uptake of this approach across the NHS could be far more rapid.

All of which work together to bring the benefits of BeST to more patients sooner.


The project uses a mixture of different methods, split into three phases.

Firstly, a small trial and in-depth interviews were carried out. This allowed the different barriers and enablers for clinicians to start using BeST to be identified and categorised. [See poster one, below left]

The second phase further develops the online training course.

This will make use of systematic reviews of the literature around cognitive behavioural approaches to treating low back pain. These reviews will help to identify evidence-based techniques to target and help overcome the barriers identified in phase one. [See poster two, below right]

Additionally, marketing materials and a communications strategy will be developed to foster awareness and uptake of the online programme among healthcare professionals.

The third phase will be an evaluation of the actual use of the online BeST programme. This will include measuring:

  1. how many people register and complete the training;
  2. how many clinicians report intending to use the BeST programme with their patients; and
  3. how many clinicians report actually using the BeST programme with their patients.

There will be no limit on the number of clinicians that can access the training, and access for NHS clinicians will be provided over a 12 month period.

To ensure that patients are getting the same benefits from BeST in routine NHS care as was seen for patients in the BeST clinical trials, information on patient outcomes, such as pain and function, will also be collected. Both before patients receive BeST and at 3 and 12 months after.







How this could benefit patients:

This project aims to train more clinicians more quickly in how to deliver BeST to patients with low back pain. Rapidly bringing this treatment to patients across the NHS to improve their quality of life and reduce their low back pain.

Additionally, the lessons learned in developing, and rolling out, the online BeST programme could be applied to other types of healthcare programmes in the future, helping to broaden their reach and increase the speed at which clinicians and patients can access new developments and reap their benefits.

You can find out more about Back Skills Training on the video below and on the Back Skills Training website.



‘Bite-sized’ summaries of CLAHRC Oxford research, providing an accessible overview of the CLAHRC programme highlights.

BITE - Back Skills Training

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