1. Gender:
 Female
 Male
2. Age: _______
3. Years in practice:  Less than 5 years
 5 to 10 years
 11 to 20 years
 More than 20 years
4. Type of practice (please check all that apply):
 Community
 Hospital-based
 Multidisciplinary
 Private practice
 Academic
 Other _____________________________
5. What category best describes your patient population:
 Adult
 Pediatric
 Adult and pediatric
6. Please indicate your training: (please check all that apply)
 Orthopaedic surgeon
 Neurosurgeon
 Fellowship: ________________________________________________
 MSc
 PhD
 Other: ____________________________________________________
7. What best describes your area of clinical interest: (please check all that apply)
 Reconstructive surgery of the spine
 Oncology involving the spine
 Sport injuries involving the spine
 Work injuries involving the spine
 Trauma involving the spine
 Other _____________________________________________________
8. What percentage of your surgical time is spent performing elective surgery on the lumbar spine?
 < 25%
 51% to 75%
 25% to 50%
 >75%
9. What best describes the proportion of your patient population with a primary complaint of lower
back or leg pain:
 < 20%
 61% to 80%
 20% to 40%
 81% to 100%
 41% to 60%
Spinal Surgeon’s Attitudes Towards Non-Physician Screening of Lower Back or Leg Pain Waiting List Patients
10. What would you estimate is the percentage of lower back or leg pain patients that are referred to
your practice, but are not accepted:






0%
1% to 5%
6% to 10%
11% to 15%
16% to 20%
>20%
11. What would you estimate is the usual outpatient wait time (i.e. date of referral till date of first
outpatient assessment) for elective cases of lower back or leg pain in your practice?:
 <1 week
 1 week to month
 1 to 3 months
 3 to 6 months
 >6 months
12. Outpatient wait times for lower back or leg pain patients in my practice are not optimal:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
13. What would you estimate is the usual surgical wait time (i.e. date of outpatient assessment till
date of surgery) for elective cases of lower back or leg pain in your practice?:
 <1 week
 1 week to month
 1 to 3 months
 3 to 6 months
 >6 months
14. Surgical wait times for lower back or leg pain patients in my practice are not optimal:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
15. How many lower back or leg pain patients do generally have to assess before you identify a
surgical candidate (i.e. screening efficiency)?:
 Less than 5 patients
 5 to 10 patients
 11 to 20 patients
 More than 20 patients
 Other: _____________________________
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Spinal Surgeon’s Attitudes Towards Non-Physician Screening of Lower Back or Leg Pain Waiting List Patients
16. My screening efficiency (identification of surgical candidates) of lower back or leg pain patients
in my practice is not optimal:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
17. I would be interested in working with non-physician clinicians (e.g. evidence-based chiropractors
or physiotherapists) to improve my screening efficiency of lower back or leg pain patients in my
practice:
 Strongly agree
 Agree
 Unsure
 Disagree
 Strongly disagree
 I already work with non-physician therapists to triage low back pain patients in my practice
 Other: ____________________________________________________________
18. What elements of a lower back or leg pain patient history would you want to have explored by a
non-physician triaging assistant? (please check all that apply):














Pain history (including, but not limited to, duration, character, aggravating and relieving factors)
Dominant location of pain (back or leg)
Demographics
Fear and avoidance (of pain) behaviours/beliefs
Psychosocial function
Prior back pain history
Occupational demands (physical and psychosocial)
Symptoms of ‘Red Flag’ conditions (e.g. cauda equina syndrome, fracture, infection, cancer)
Presence of ‘Yellow Flags’ (e.g. receipt of disability benefits, ongoing litigation, smoker, high
emotional stress)
Exploration for prior back treatments (e.g. surgical and non-surgical, was conservative care
trialed)
Review of imaging findings
Use of IV drugs or steroids
Current physical functional status/disabilities
Other: ____________________________________________________________
____________________________________________________________
19. If the items I have endorsed in question #17 could be reliably captured in a standardized patient
history form, by a non-physician therapist, I would find this helpful for triaging lower back or
leg pain patients:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
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Spinal Surgeon’s Attitudes Towards Non-Physician Screening of Lower Back or Leg Pain Waiting List Patients
20. What elements of a lower back or leg pain patient exam would you want to have performed by a
non-physician triaging assistant? (please check all that apply):









Orthopedic hip exam
Standard orthopaedic and neurological tests for low back and/or leg pain
Straight leg raise, supine
Straight leg raise, seated
Measurement for lower limb atrophy
Lower limb vascular exam
Lumbar spine range of motion
Waddell’s and other nonorganic signs
Other: ____________________________________________________________
____________________________________________________________
21. If the items I have endorsed in question #19 could be reliably captured in a standardized patient
exam form, by a non-physician therapist, I would find this helpful for triaging lower back or leg
pain patients:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
22. I would like to have a health-related quality of life questionnaire (e.g. Short-Form 36)
administered to lower back or leg pain patients by a non-physician triaging assistant:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
23. I would like to have psychological screening questionnaire(s) (e.g. for depression or pain
behaviors) administered to lower back or leg pain patients by a non-physician triaging assistant:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
24. What signs or symptoms associated with a lower back or leg pain patient history or exam would
you consider a strong indication for surgical assessment (please check all that apply):
 Signs or symptoms of ‘Red Flag’ conditions (e.g. fracture, infection, malignancy, progressive
neurological deficits, cauda equina syndrome)
 Absence of ‘Yellow Flags’ (e.g. receipt of disability benefits, ongoing litigation, smoker, high
emotional stress)
 Leg-dominant pain
 Severe low back pain that has not responded to conservative therapy
 Correlating neurological findings
 Correlating imaging findings
 Other: _______________________________________________________________
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Spinal Surgeon’s Attitudes Towards Non-Physician Screening of Lower Back or Leg Pain Waiting List Patients
25. If any of the items I have endorsed in question #24 was clearly identified by a non-physician
therapist for a lower back or leg pain patient, I would still want to assess the patient myself:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
26. If any of the items I have endorsed in question #24 was suspected by a non-physician therapist
for a lower back or leg pain patient, I would still want to assess the patient myself:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
27. If none of the items I have endorsed in question #24 were identified or suspected by a nonphysician therapist for a lower back or leg pain patient, I would be comfortable not assessing the
patient myself and referring them for non-surgical management:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
28. Even if a non-physician therapist was capable of reliably providing me with triaging information
that I felt was valuable in decision-making, my lower back or leg pain patients would still expect
to be seen by me prior to any referral:
Strongly Agree 
Agree 
Undecided 
Disagree 
Strongly Disagree 
Please share with us any other thoughts you may have on non-physician triage of spinal
surgeon’s lower back or leg pain waiting list patients.
______
- Thank You for Your Time
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