The Multidisciplinary Approach in the Assessment and Management of Lumbar Spine Pathologies; the Journey from the Emergency Department (ED) to the Specialist Outpatient Clinics (SOCs)

Learning objectives:

1. Summarise the latest evidence on the management of spine-related leg pain.

2. Discuss the role of an Advanced Practice Physiotherapist (APP) in Singapore when assessing and managing lumbar spine pathologies at the Emergency Department (ED).

3. Outline the clinical decision process by the spine specialist and pain specialist in the patients journey. 

4. Summarise the latest evidence on medications prescribed for acute & chronic LBP at ED and at SOCs.

Symposium Convenor:  Dr Poonam Pal, Physiotherapy Center @ Harbourfront and Rehab Alliance 

Biography:  Dr Pal graduated with a PhD titled “Cumulative loads on the lumbar spine during wool harvesting” from University of Otago in 2010. Her PhD scholarship was funded by Vernon Willey Trust Fellowship and Health Research Council of New Zealand. 

She has worked in various public organisations in Singapore and her last employment was at Changi General Hospital where she worked for nearly a decade.  She has vast experience in musculoskeletal physiotherapy at the Accident & Emergency department and outpatient clinics. Her areas of expertise are in the assessment and management of spinal conditions and has a special interest in the assessment and management of chronic pain. Besides clinical practice she enjoys mentoring and teaching junior colleagues.

Speaker:  Professor Annina Schmid, Oxford University, United Kingdom

Topic Title: What is the evidence for management of people with spine-related leg pain?

Biography:  Prof Schmid is a Specialist Musculoskeletal Physiotherapist and a Neuroscientist affiliated with the Nuffield Department of Clinical Neurosciences at Oxford University in the UK. She leads the Neuromusculoskeletal Health and Science Lab (https://www.ndcn.ox.ac.uk/research/neuromusculoskeletal-health-and-science-lab) which uses a translational and interdisciplinary approach to study the pathophysiology of neuromusculoskeletal conditions with the ultimate goal to improve management for patients. Prof Schmid has a particular interest in entrapment neuropathies and neuropathic pain and the development of precision therapy for these patients. 

Prof Schmid has published her work in leading clinical and basic science journals and regularly presents her work at national and international meetings. Her research contributions have been recognised by the award of several prizes (most recently the Emerging Leaders Prize in Pain Research, Medical Research Foundation) and competitive fellowships. She was the first allied health professional to win a prestigious Clinical Research Career Development Fellowship from the Wellcome Trust. 

In addition to her research activities, Prof Schmid teaches postgraduate courses related to pain and neuroscience internationally. She also maintains a weekly caseload as a specialist musculoskeletal Physiotherapist both privately and in the NHS. Further information can be found at www.neuro-research.ch.

Speaker:  Dr Dinesh Shree Kumar, Changi General Hospital

Topic Title: The spine specialist perspective on the assessment and management of lumbar pathologies; when to refer on, monitor or operate.

Biography: Dr Dinesh Shree Kumar is currently the Head of SingHealth Duke-NUS Spine Centre and oversees the coordination of spine surgery and spine care for patients in the SingHealth Cluster. He is also the Director of Spine Surgery in Changi General Hospital (CGH). Some of his initiatives in his current appointment include the introduction of Minimally Invasive Spine surgery with robotics/computer navigation at CGH and the development of an Integrated Spine Service in CGH consisting of both Neurosurgeons and Orthopaedic Surgeons.

He has recently spearheaded the Min Inv Computer Guided Spine Surgery Training platform CREST@CGH. He receives visiting surgeons from the region every who are doing proctorships and fellowships in Minimally invasive spine surgery. He has successfully setup the CGH-NNI Spine Centre which is an integrated Spine Centre consisting of Neurosurgeons, Orthopaedic Surgeons and Rehab Physicians offering a one stop service to patients with spinal disorders.

Speaker: Dr Prit Anand Singh, Changi General Hospital  

Topic Title: When to refer to a Pain Specialist; at the ED or SOC? A review of evidence and local experience.

Biography: Dr Singh a Senior Consultant with the Department of Anaesthesia and Surgical Intensive Care at Changi General Hospital. He is the Director of Chronic Pain Management Service at CGH and leads Regional Anaesthesia & Pain medicine at CGH

He also holds the position of Clinical Assistant Professor at Duke NUS Medical School. He is also the Honorary Secretary for the Pain Association of Singapore.

His areas of interest are Chronic pain management, Pain with dependence/ addiction issues, Ultrasound guided RA/Pain interventions, Perioperative Point of Care Ultrasonography, Crisis Resource Management simulation/ Debriefing and Prehospital Emergency Evacuation.

Dr Singh presents zealously at both national and international conferences.

Speaker: Ms Ong Pei Gin, Principal Physiotherapist, Tan Tock Seng Hospital

Topic Title: The Singapore outlook: The assessment and management strategies in lumbar spine pathologies by an ED APP.

Biography: Ms Ong completed her Masters in Advanced Neuromusculoskeletal Physiotherapy at King's College London in 2016. After graduation, she has been actively involved in managing patients with musculoskeletal pain across various clinical settings such as the Emergency Department, Musculoskeletal Physiotherapy Outpatient Clinic and Pain Management Clinic.

She completed her ED APP training in June 2022 and started her journey as an ED APP in TTSH emergency department since then.  

She has a special interest in assessing and managing patients with chronic/ complex musculoskeletal pain conditions and empowering them to return to their daily function.