N003 – PRM PC for patients with low back pain and lombo-sacral radiculopathy

Accredited in September 2010

The Centre of the Rehabilitation, Physical and Sport Medicine
Vilnius University Hospital Santariškių klinikos
Santariškių str. 2
Board certification 2008

Full description (pdf.file)


Background: The Programme is performed in the out-patient rehabilitation department, which is part of the PRM and Sports Medicine Centre in the University Hospital. The organization of the Programme is based on: National Regulation, on the White Book on Physical and Rehabilitation Medicine in Europe, and on International scientific guidelines and recommendations.

Target population and procedure: The Programme is focused on adult patients of any gender and age, suffering from low back pain combined with lumbosacral radiculopathy, causing person’s moving or self-care impairment, at any phase of its development: acute, sub-acute or chronic. Patients are referred to our Department directly by their GPs or by other consultants. The Programme is funded by the National Health Insurance. Safety and patient rights are defined by National regulations. Each patient signs an informed consent.

The main goals of the Programme are: to relieve pain, to improve patient’s functioning and activity, to enable participation, to reduce sick-leaves duration and working absenteeism, to prevent pain recurrence and chronic evolution.

The Department permanent manpower consists of 2 PRM specialists, 4 physiotherapists, 1 occupational therapist, 1 psychologist, 1 social worker, 4 nurses, 3 massage specialists. Other professionals may contribute to the Programme on demand. The Department is equipped with a wide range of facilities, which include: 3 consultation rooms, 4 exercise rooms, one is equipped with spinal traction system, 2 pools (one with spinal traction equipment), 4 rooms of physical modalities, 3 massage rooms one room for acupuncture procedures and manual therapy procedures, some space designed for patients rest; Different imaging techniques (X-rays, CT, MRI, ultrasound imaging and others) are available in the Hospital.

The approach to the Programme is multi-professional. The PRM specialist has an overall leadership on the team and is “the patient’s manager”. He/she is responsible for the initial patient’s evaluation, the set up of an appropriate strategy, the team coordination and further patient’s follow-up.

Patient’s assessment is based on the evaluation presented in the White Book on Physical and Rehabilitation Medicine in Europe, appendix IV and suggested in International guidelines. The members of the team evaluate the patient subsequently. On the basis of this comprehensive evaluation, the initial PRM strategy is adjusted and the rehabilitation plan is confirmed. It may be adapted according to patient’s clinical and functional findings, after regular team meetings.

Treatment methods to relieve pain consist of physical modalities (especially electrotherapy and ultrasounds), massage and tractions in pool. Coping with pain is favoured by psychotherapy and relaxation. In order to enhance functioning abilities, we use exercises in pools, exercise therapy (individual and in groups). Return to work and prevention are based on effort training, consultations for working place adjustments and ergonomics.
All patient’s medical and functional information, assessment and further monitoring data is recorded manually into a standardised medical documentation. A standardised discharge report with further recommendations is written in several copies, for the patient and for his/her GP. All the Programme documents are stored in the clinical archive and are accessible for periodic internal or external audit and outcomes assessment.

Long term outcomes monitoring of our patients has been started recently and the data analysis is in progress. These efforts should contribute to a quality improvement approach of our programme in the following years.



The programme fits the European accreditation standards.

Although the official title is “PRM Programme for patients with Low Back Pain with lumbar roots neuropathy”, this programme is mainly focused on Low Back Pain.Radiculopathy rather appears as an inclusion criterion, than a core issue of the programme.

The programme is consistent with current International recommendations. However, the committee agrees with the author on that scientific evidence is still lacking about the efficiency of some physical modalities, which are traditionally used against LBP. Event though, low evidence doesn’t mean “evidence against” those modalities. Additional information about this issue will be added to the eBook, with respect to forthcoming scientific data.