Effectiveness of a Classification-based Approach to Low Back Pain in Primary Care - a Benchmarking Controlled Trial

Overview

Journal J Rehabil Med

Specialty Rehabilitation Medicine

Date 2024 Apr 21

PMID 38643363

Authors

Anna Sofia Simula

Antti Malmivaara

Neill Booth

Jaro Karppinen

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care.

Design: A benchmarking controlled trial design was used.

Subjects/patients: Three primary healthcare areas and 654 low back pain patients with or without sciatica.

Methods: Classification-based care (using the STarT Back Tool) was implemented using organizational-, healthcare professional-, and patient-level interventions. The primary outcome was change in Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF-20) from baseline to 12 months.

Results: No difference was found between the intervention and control in change in PROMIS PF-20 over the 12-month follow-up (mean difference 0.33 confidence interval -2.27 to 2.9, p = 0.473). Low back pain-related healthcare use, imaging, and sick leave days were significantly lower in the intervention group. Reduction in intensity of low back pain appeared to be already achieved at the 3-month follow-up (mean difference -1.3, confidence interval -2.1 to -0.5) in the intervention group, while in the control group the same level of reduction was observed at 12 months (mean difference 0.7, confidence interval -0.2 to 1.5, treatment*time p = 0.003). Conclusion: Although classification-based care did not appear to influence physical functioning, more rapid reductions in pain intensity and reductions in healthcare use and sick leave days were observed in the intervention group.

References

Fullen B, Maher T, Bury G, Tynan A, Daly L, Hurley D . Adherence of Irish general practitioners to European guidelines for acute low back pain: a prospective pilot study. Eur J Pain. 2006; 11(6):614-23. DOI: 10.1016/j.ejpain.2006.09.007. View

Ogbeivor C, Elsabbagh L . Management approach combining prognostic screening and targeted treatment for patients with low back pain compared with standard physiotherapy: A systematic review & meta-analysis. Musculoskeletal Care. 2021; 19(4):436-456. DOI: 10.1002/msc.1541. View

Simula A, Ruokolainen O, Oura P, Lausmaa M, Holopainen R, Paukkunen M . Association of STarT Back Tool and the short form of the Örebro Musculoskeletal Pain Screening Questionnaire with multidimensional risk factors. Sci Rep. 2020; 10(1):290. PMC: 6959304. DOI: 10.1038/s41598-019-57105-3. View

Becker A, Leonhardt C, Kochen M, Keller S, Wegscheider K, Baum E . Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial. Spine (Phila Pa 1976). 2008; 33(5):473-80. DOI: 10.1097/BRS.0b013e3181657e0d. View

Buchbinder R, Underwood M, Hartvigsen J, Maher C . The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020; 161 Suppl 1:S57-S64. PMC: 7434211. DOI: 10.1097/j.pain.0000000000001869. View

Ramsay C, Eccles M, Grimshaw J, Steen N . Assessing the long-term effect of educational reminder messages on primary care radiology referrals. Clin Radiol. 2003; 58(4):319-21. DOI: 10.1016/s0009-9260(02)00524-x. View

Nicholas M . The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2006; 11(2):153-63. DOI: 10.1016/j.ejpain.2005.12.008. View

Foster N, Mullis R, Hill J, Lewis M, Whitehurst D, Doyle C . Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Ann Fam Med. 2014; 12(2):102-11. PMC: 3948756. DOI: 10.1370/afm.1625. View

Gaspar F, Thiese M, Wizner K, Hegmann K . Guideline adherence and lost workdays for acute low back pain in the California workers' compensation system. PLoS One. 2021; 16(6):e0253268. PMC: 8211224. DOI: 10.1371/journal.pone.0253268. View

10.

Simpson P, Holopainen R, Schutze R, OSullivan P, Smith A, Linton S . Training of Physical Therapists to Deliver Individualized Biopsychosocial Interventions to Treat Musculoskeletal Pain Conditions: A Scoping Review. Phys Ther. 2021; 101(10). DOI: 10.1093/ptj/pzab188. View

11.

Deyo R, Mirza S, Turner J, Martin B . Overtreating chronic back pain: time to back off?. J Am Board Fam Med. 2009; 22(1):62-8. PMC: 2729142. DOI: 10.3122/jabfm.2009.01.080102. View

12.

Hill J, Dunn K, Main C, Hay E . Subgrouping low back pain: a comparison of the STarT Back Tool with the Orebro Musculoskeletal Pain Screening Questionnaire. Eur J Pain. 2009; 14(1):83-9. PMC: 2809923. DOI: 10.1016/j.ejpain.2009.01.003. View

13.

Linton S, Nicholas M, MacDonald S . Development of a short form of the Örebro Musculoskeletal Pain Screening Questionnaire. Spine (Phila Pa 1976). 2010; 36(22):1891-5. DOI: 10.1097/BRS.0b013e3181f8f775. View

14.

Malmivaara A . Benchmarking Controlled Trial--a novel concept covering all observational effectiveness studies. Ann Med. 2015; 47(4):332-40. PMC: 4673508. DOI: 10.3109/07853890.2015.1027255. View

15.

Simula A, Jenkins H, Holopainen R, Oura P, Korniloff K, Hakkinen A . Transcultural adaption and preliminary evaluation of "understanding low back pain" patient education booklet. BMC Health Serv Res. 2020; 19(1):1010. PMC: 6936060. DOI: 10.1186/s12913-019-4854-y. View

16.

Rose M, Bjorner J, Becker J, Fries J, Ware J . Evaluation of a preliminary physical function item bank supported the expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol. 2007; 61(1):17-33. DOI: 10.1016/j.jclinepi.2006.06.025. View

17.

Williams C, Maher C, Hancock M, McAuley J, McLachlan A, Britt H . Low back pain and best practice care: A survey of general practice physicians. Arch Intern Med. 2010; 170(3):271-7. DOI: 10.1001/archinternmed.2009.507. View

18.

Wertli M, Rasmussen-Barr E, Weiser S, Bachmann L, Brunner F . The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014; 14(5):816-36.e4. DOI: 10.1016/j.spinee.2013.09.036. View

19.

Simula A, Malmivaara A, Booth N, Karppinen J . A classification-based approach to low back pain in primary care - protocol for a benchmarking controlled trial. BMC Fam Pract. 2020; 21(1):61. PMC: 7137427. DOI: 10.1186/s12875-020-01135-8. View

20.

Graves J, Fulton-Kehoe D, Jarvik J, Franklin G . Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res. 2013; 49(2):645-65. PMC: 3864604. DOI: 10.1111/1475-6773.12098. View