Abstract
Background and purpose
The STarT Back trial demonstrated benefits from a stratified primary care model that targets low back pain (LBP) treatment according to patient prognosis (low-, medium-, or high-risk). The current IMPaCT Back study implemented this approach in everyday primary care to investigate; i) changes in GPs' and physiotherapists' attitudes, confidence and behaviours, ii) patients' clinical outcomes, and iii) cost-effectiveness.
Method
This quality improvement study involved 5 GP practices (65 GPs and 34 physiotherapists) with before and after implementation cohorts of consecutive LBP consulters using an intention to treat analysis to compare patient data. Phase 1: Usual care data collection from clinicians and patients (pre-implementation). Phase 2: Introduction of prognostic screening and targeted treatment including a minimal GP intervention (low-risk group), systematic referral to physiotherapy (medium-risk group) and to psychologically informed physiotherapy (high-risk group). Phase 3: Post-implementation data collection from clinicians and patients.
Results
922 patients participated (368 in Phase 1 and 554 in Phase 3) with similar baseline characteristics (mean age 53 v 54 years, disability (RMDQ) 8.7 v 8.4). Significant differences in favour of targeted treatment were demonstrated in clinicians' attitudes and confidence, and RMDQ 6-month change scores (mean difference 0.7 [95% CI 0.1, 1.4]). Health care cost savings were also identified, in addition to an average of 3.5 fewer days off work during study follow-up.
Conclusion
A stratified model of LBP management can be successfully introduced into real-life primary care, improving clinicians' attitudes and confidence and patient disability outcomes and reducing the economic burden of LBP.
Conflicts of Interest
None
Source of Funding
The Health Foundation
This abstract has not been previously published in whole or substantial part, it has been presented at international meetings in 2011, but not yet a national meeting.
