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The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP--a non randomised controlled trial.
BMC Musculoskelet Disord. 2013 Dec 05; 14:342.BM

Abstract

BACKGROUND

Low back pain (LBP) is costly to society and improving patient outcomes is a priority. Stratifying LBP patients into more homogenous groups is advocated to improve patient outcome. The STarT Back tool, a prognostic screening tool has demonstrated efficacy and greater cost effectiveness in physiotherapy settings. The management of LBP patients in groups is common but to date the utility of the STarT Back tool in group settings has not been explored. The aim of this study is to determine if the implementation of 'stratified care' when delivered in a group setting will lead to significantly better physical and psychological outcomes and greater cost effectiveness in LBP patients compared to a bestcare historical control group.

METHODS/DESIGN

This study is a non randomised controlled trial. Low back pain patients recruited from the Waterford Primary Care area (population = 47,000) will be stratified into low, medium or high risk of persisting symptoms using the STarT Back Tool. Low risk patients will be offered a single one off education/exercise class offering positive messages on LBP management in line with recommended guidelines. Medium risk patients will be offered a 12 week group exercise/education intervention addressing their dominant physical obstacles to recovery. A 12 week group cognitive behavioural approach will be delivered to the high risk patients, characterised by the presence of high levels of psychosocial prognostic factors. These patients will be compared with a historical control group where therapists were blinded as to the risk stratification of patients and a generic group intervention was delivered to all patients, irrespective of their initial risk stratification. The primary outcome measure will be disability (Roland Morris Disability Questionnaire). Secondary outcomes will include back pain intensity (Visual Analogue Scale), distress (Distress and Risk Assessment Method), back beliefs (Back Beliefs Questionnaire), health status (Euroqol), global benefit (7 point likert scale), satisfaction (7 point likert scale), cost effectiveness and functional status. Outcome will be measured at baseline, 12 weeks and 6 months.

DISCUSSION

This paper details the rationale, design, methods, planned analysis and operational aspects of a study examining the utility of the STarT Back Tool as a 'stratification tool for targeted treatment' in a group intervention.

TRIAL REGISTRATION

Current controlled trials: ACTRN12613000431729.

Authors+Show Affiliations

School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. susane.murph@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24308746

Citation

Murphy, Susan E., et al. "The Effectiveness of a Stratified Group Intervention Using the STarTBack Screening Tool in Patients With LBP--a Non Randomised Controlled Trial." BMC Musculoskeletal Disorders, vol. 14, 2013, p. 342.
Murphy SE, Blake C, Power CK, et al. The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP--a non randomised controlled trial. BMC Musculoskelet Disord. 2013;14:342.
Murphy, S. E., Blake, C., Power, C. K., & Fullen, B. M. (2013). The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP--a non randomised controlled trial. BMC Musculoskeletal Disorders, 14, 342. https://doi.org/10.1186/1471-2474-14-342
Murphy SE, et al. The Effectiveness of a Stratified Group Intervention Using the STarTBack Screening Tool in Patients With LBP--a Non Randomised Controlled Trial. BMC Musculoskelet Disord. 2013 Dec 5;14:342. PubMed PMID: 24308746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP--a non randomised controlled trial. AU - Murphy,Susan E, AU - Blake,Catherine, AU - Power,Camillus K, AU - Fullen,Brona M, Y1 - 2013/12/05/ PY - 2013/04/04/received PY - 2013/11/27/accepted PY - 2013/12/7/entrez PY - 2013/12/7/pubmed PY - 2014/5/3/medline SP - 342 EP - 342 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 14 N2 - BACKGROUND: Low back pain (LBP) is costly to society and improving patient outcomes is a priority. Stratifying LBP patients into more homogenous groups is advocated to improve patient outcome. The STarT Back tool, a prognostic screening tool has demonstrated efficacy and greater cost effectiveness in physiotherapy settings. The management of LBP patients in groups is common but to date the utility of the STarT Back tool in group settings has not been explored. The aim of this study is to determine if the implementation of 'stratified care' when delivered in a group setting will lead to significantly better physical and psychological outcomes and greater cost effectiveness in LBP patients compared to a bestcare historical control group. METHODS/DESIGN: This study is a non randomised controlled trial. Low back pain patients recruited from the Waterford Primary Care area (population = 47,000) will be stratified into low, medium or high risk of persisting symptoms using the STarT Back Tool. Low risk patients will be offered a single one off education/exercise class offering positive messages on LBP management in line with recommended guidelines. Medium risk patients will be offered a 12 week group exercise/education intervention addressing their dominant physical obstacles to recovery. A 12 week group cognitive behavioural approach will be delivered to the high risk patients, characterised by the presence of high levels of psychosocial prognostic factors. These patients will be compared with a historical control group where therapists were blinded as to the risk stratification of patients and a generic group intervention was delivered to all patients, irrespective of their initial risk stratification. The primary outcome measure will be disability (Roland Morris Disability Questionnaire). Secondary outcomes will include back pain intensity (Visual Analogue Scale), distress (Distress and Risk Assessment Method), back beliefs (Back Beliefs Questionnaire), health status (Euroqol), global benefit (7 point likert scale), satisfaction (7 point likert scale), cost effectiveness and functional status. Outcome will be measured at baseline, 12 weeks and 6 months. DISCUSSION: This paper details the rationale, design, methods, planned analysis and operational aspects of a study examining the utility of the STarT Back Tool as a 'stratification tool for targeted treatment' in a group intervention. TRIAL REGISTRATION: Current controlled trials: ACTRN12613000431729. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/24308746/The_effectiveness_of_a_stratified_group_intervention_using_the_STarTBack_screening_tool_in_patients_with_LBP__a_non_randomised_controlled_trial_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-14-342 DB - PRIME DP - Unbound Medicine ER -