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The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial.
Trials. 2018 Jun 08; 19(1):315.T

Abstract

BACKGROUND

Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. Hence this study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice.

METHODS/DESIGN

The study is a two-armed randomised controlled trial in primary care in the Regions of Southern and Central Denmark (2.5 million citizens). Patients with non-specific low back will be recruited by paticpating GPs. Patients are randomised to either (1) stratified care or (2) current practice at participating physiotherapy clinics. In the stratified care arm, the intervention is based on the patient's STarT Back Tool classification and trained accordingly, whereas physiotherapists in the current pratice arm are blinded to the STarT score. Primary outcomes in the trial will be group differences in time off work, improvement in LBP disability measured by the Roland Morris Disability Questionnaire (RMDQ) and patient-reported global change. Secondary measures will be pain intensity, patient satisfaction, data on patient healthcare resource utilisation and quality-adjusted life year based on the EQ-5D-5L.

DISCUSSION

Stratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. Thus, if effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT02612467 . Registered on 16 November 2015.

Authors+Show Affiliations

Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, 5500, Middelfart, Denmark. lars.morsoe@rsyd.dk. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. lars.morsoe@rsyd.dk.Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. Spine Centre of Southern Denmark, Odense, Denmark.Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.Department for Health Provision, Region of Central Denmark, Viborg, Denmark.Physiothery Primary Care Consultant, Region of Southern Denmark, Vejle, Denmark.Department of Business and Economics, COHERE, University of Southern Denmark, Odense, Denmark.Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, 5500, Middelfart, Denmark.Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.Department for Health Provision, Region of Central Denmark, Viborg, Denmark. Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.

Pub Type(s)

Clinical Trial Protocol
Journal Article

Language

eng

PubMed ID

29884217

Citation

Morso, Lars, et al. "The Effectiveness of a Stratified Care Model for Non-specific Low Back Pain in Danish Primary Care Compared to Current Practice: Study Protocol of a Randomised Controlled Trial." Trials, vol. 19, no. 1, 2018, p. 315.
Morso L, Schiøttz-Christensen B, Søndergaard J, et al. The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial. Trials. 2018;19(1):315.
Morso, L., Schiøttz-Christensen, B., Søndergaard, J., Andersen, N. V., Pedersen, F., Olsen, K. R., Jensen, M. S., Hill, J., & Christiansen, D. H. (2018). The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial. Trials, 19(1), 315. https://doi.org/10.1186/s13063-018-2685-5
Morso L, et al. The Effectiveness of a Stratified Care Model for Non-specific Low Back Pain in Danish Primary Care Compared to Current Practice: Study Protocol of a Randomised Controlled Trial. Trials. 2018 Jun 8;19(1):315. PubMed PMID: 29884217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial. AU - Morso,Lars, AU - Schiøttz-Christensen,Berit, AU - Søndergaard,Jens, AU - Andersen,Nils-Bo de Vos, AU - Pedersen,Flemming, AU - Olsen,Kim Rose, AU - Jensen,Morten Sall, AU - Hill,Jonathan, AU - Christiansen,David Høyrup, Y1 - 2018/06/08/ PY - 2017/10/04/received PY - 2018/05/11/accepted PY - 2018/6/10/entrez PY - 2018/6/10/pubmed PY - 2019/3/15/medline KW - Cost effectiveness KW - Randomised controlled trial KW - STarT back tool KW - Stratified care SP - 315 EP - 315 JF - Trials JO - Trials VL - 19 IS - 1 N2 - BACKGROUND: Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. Hence this study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice. METHODS/DESIGN: The study is a two-armed randomised controlled trial in primary care in the Regions of Southern and Central Denmark (2.5 million citizens). Patients with non-specific low back will be recruited by paticpating GPs. Patients are randomised to either (1) stratified care or (2) current practice at participating physiotherapy clinics. In the stratified care arm, the intervention is based on the patient's STarT Back Tool classification and trained accordingly, whereas physiotherapists in the current pratice arm are blinded to the STarT score. Primary outcomes in the trial will be group differences in time off work, improvement in LBP disability measured by the Roland Morris Disability Questionnaire (RMDQ) and patient-reported global change. Secondary measures will be pain intensity, patient satisfaction, data on patient healthcare resource utilisation and quality-adjusted life year based on the EQ-5D-5L. DISCUSSION: Stratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. Thus, if effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02612467 . Registered on 16 November 2015. SN - 1745-6215 UR - https://www.unboundmedicine.com/medline/citation/29884217/The_effectiveness_of_a_stratified_care_model_for_non_specific_low_back_pain_in_Danish_primary_care_compared_to_current_practice:_study_protocol_of_a_randomised_controlled_trial_ L2 - https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2685-5 DB - PRIME DP - Unbound Medicine ER -