Can using patient reports of low back pain help to better direct patients to treatments?
We invited adult patients receiving primary care for nonspecific LBP to provide data 2 weeks after their primary care visit and follow-up data 2 and 6 months (primary end point) later. The STarT Back risk stratification strategy matches treatments for LBP to physical and psychosocial obstacles to re...
| Main Author: | |
|---|---|
| Corporate Author: | |
| Format: | eBook |
| Language: | English |
| Published: |
[Washington, D.C.]
Patient-Centered Outcomes Research Institute
2018, [2018]
|
| Series: | Final research report
|
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | We invited adult patients receiving primary care for nonspecific LBP to provide data 2 weeks after their primary care visit and follow-up data 2 and 6 months (primary end point) later. The STarT Back risk stratification strategy matches treatments for LBP to physical and psychosocial obstacles to recovery using patient-reported data (the STarT Back Tool) to categorize patients at low, medium or high risk of persistent disabling pain. Primary care providers in the intervention group attended 6 didactic sessions to improve their understanding of the management of LBP and received in-person training in the use of the risk stratification tool that had been incorporated into electronic health records. Physical therapists in the intervention clinics received 5 days of intensive training. Primary care providers and physical therapists in the control clinics received no training. We collected patient-reported data through telephone interviews. BACKGROUND: The Subgroups for Targeted Treatment Risk Stratification (STarT) Back strategy for categorizing and treating patients with low back pain (LBP) improved patients' physical function while reducing costs in the United Kingdom. This trial evaluated the effect of implementing an adaptation of this approach in a health care setting in the United States. METHODS: The Matching Appropriate Treatments to Consumers' Healthcare needs (MATCH) trial was a pragmatic cluster randomized trial with a preintervention baseline period. The study recruited patients for a baseline phase of observation and follow-up, then taught the providers how to conduct the interventions, and then recruited another study population and followed them for 6 months. We recruited patients from primary care clinics in an integrated health care system in western Washington State. Six primary care clinics were pair-randomized, 3 to training in the STarT Back strategy and 3 to serve as controls. Primary outcomes were back-related physical function and pain severity. We estimated intervention effects by comparing mean changes in patient outcomes at 2 and 6 months follow-up between intervention and control clinics. We estimated differences in change scores by trial arm and time period using linear mixed-effect models. Secondary outcomes included patients' health care use (eg, physician and physical therapy visits, imaging studies, opioid prescriptions) using data from electronic health records. RESULTS: A total of 2138 patients with LBP visited the intervention clinics and 2571 the control clinics over the course of the study. Overall, 36% of patients provided baseline data on patient outcomes. Follow-up rates were 93% at 2 months and 91% at 6 months. Participation and follow-up rates were similar in the intervention and control groups. There was no significant difference between the intervention and control groups in the primary outcomes at 6 months. Specifically, mean improvement in function in the control group exceeded that in the intervention group by 0.50 on RMD scale (95% CI, −0.55 to 1.55; P = .349), and mean improvement in pain severity was 0.13 greater in the control group than in the intervention group (95% CI, −0.37 to 0.63; P = .61). The intervention had no significant effect on any patient outcomes at 2 or 6 months or on health care use. CONCLUSIONS: A resource-intensive intervention to support stratified care for LBP in a US health care setting had no effect on patient outcomes or health care use. LIMITATIONS: The main limitations of our evaluation were that less than half of patients visiting the clinics for LBP provided data for the outcomes analyses, and the trial was restricted to a single health care system |
|---|---|
| Physical Description: | 1 PDF file (43 pages) illustrations |