Stratified primary care management for low back pain beneficial

January 01, 0001

Stratified primary care management for low back pain beneficial

Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). The researchers compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control). 1573 adults (aged greater than or equal to 18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. 851 patients were assigned to the intervention (n=568) and control groups (n=283).

Overall, adjusted mean changes in Roland Morris Disability Questionnaire (RMDQ) scores were significantly higher in the intervention group than in the control group at 4 months (4.7 vs 3.0, between-group difference 1.81) and at 12 months (4.3 vs 3.3, 1.06), equating to effect sizes of 0.32 and 0.19, respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0.039 additional quality- adjusted life years) and cost savings (£240.01 vs £274.40) compared with the control group.

The researchers concluded: "The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care."

I thought we did this by using yellow flags and red flags.

For the full abstract, click here.

The Lancet 378(9802):1560-1571, 29 October 2011 © 2011 Elsevier Limited
Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Jonathan C Hill, David GT Whitehurst, Martyn Lewis et al. Correspondence to Jonathan Hill: j.hill@cphc.keele.ac.uk

Category: M. Musculoskeletal. Keywords: management, low back pain, best practice, stratified, randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 25 November 2011

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