Fig. 1

Overview of the PT in primary care screening and navigation process. The physiotherapist (PT) will help the patient navigate the healthcare system in three stages. First, any red flags identified will lead to emergency, urgent, or soon referrals to the emergency department, physician, and/or imaging. Second, the patient history, examination findings, and validated questionnaires, when appropriate, will be used to determine if other healthcare providers are needed for this patient’s care. Third, the PT will use the STarT back risk stratification tool (individuals screened as low, medium, or high risk of ongoing pain and disability [27]) to guide referral pathways for physiotherapy. The matched low-risk pathway is a brief primary care intervention (reassurance, advice, and exercise) with no referral. The medium-risk pathway involves a referral for usual physiotherapy care in addition to the brief intervention. The high-risk matched pathway includes referral for a combined physical and psychologically informed treatment approach which aims to address barriers to recovery, facilitate increases in activity, and address unhelpful back pain beliefs and behaviors. This treatment approach has been described in more detail elsewhere [56]. GAD-7 General Anxiety Disorder-7, NSAIDS nonsteroidal anti-inflammatory drugs, OT occupational therapy, PC primary care, PHQ-9 Patient Health Questionnaire-9, PTSD post-traumatic stress disorder