Abstract
Background
Stratifying patients with Low Back Pain (LBP) using the STarT Back Tool and delivering targeted treatment has demonstrated efficacy in individual physiotherapy settings. Physiotherapy interventions for LBP patients are often delivered in groups. This study aimed to explore the sustainability and cost effectiveness of a group stratified intervention in primary care.
Methods
This non-randomised controlled trial compared a novel group stratified intervention to a historical non-stratified group control. Patients from 30 GP practices in Waterford Primary Care were stratified and offered a matched targeted group intervention. The historical control received a generic group intervention. The primary outcome measure was disability (RMDQ) at 12 weeks. A cost effectiveness analysis was also undertaken. Analysis was by intention to treat. Ethical approval was obtained
Results
251 patients in the new stratified intervention and 332 in the historical control were included. Overall adjusted mean changes in the RMDQ scores were higher in the stratified intervention than in the control arm [p=0.028]. Exploring the risk groups individually the high-risk (HR) stratified group demonstrated better outcome over the controls (p=0.031)]. The medium risk (MR) stratified intervention demonstrated equally good outcomes (p=0.125), and low risk (LR) stratified patients, despite less intervention did as well as the historical controls [p=0.993]. With respect to cost effectiveness, the high risk intervention delivered a larger reduction in disability per unit time and proved equally cost effective as the medium risk intervention (HR €44.50 v MR €45.43)
Conclusion
Group stratified care provides both a clinically effective and cost effective model of care for LBP patients.
Conflicts of interest: No conflicts of interest
Source of Funding: Funded by an unrestricted educational grant from Pfizer Healthcare Ireland.
