Evaluation of a risk-stratification strategy to improve primary care for low back pain: the MATCH cluster randomised trial protocol

Autor: Katherine Talbert Estlin, Jonathan C. Hill, Mark P. Jensen, Georgie Brewer, Pam Rock, Gail Sowden, Sarah Evers, Diane Piekara, Karen J. Sherman, John Yeoman, Dan Cherkin, Robert D. Wellman, Anne Marie Laporte, Benjamin H. Balderson, Rene J. Hawkes, Andrea J. Cook, Martin D. Levine, Clarissa Hsu, Nadine E. Foster
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Sports medicine
law.invention
Study Protocol
Disability Evaluation
0302 clinical medicine
Clinical Protocols
Randomized controlled trial
law
Surveys and Questionnaires
Health care
Clinical endpoint
Back pain
Electronic Health Records
Orthopedics and Sports Medicine
Prospective Studies
030212 general & internal medicine
Cluster randomised controlled trial
Pain Measurement
Education
Medical

Primary care
Prognosis
Low back pain
STarT back
3. Good health
Utilization
medicine.symptom
Psychosocial
Adult
medicine.medical_specialty
Guidelines
Risk Assessment
Risk-stratification
03 medical and health sciences
Rheumatology
medicine
Humans
Quality improvement
Primary Health Care
business.industry
Systems
United Kingdom
United States
Physical Therapists
Patient outcomes
Physical therapy
business
Low Back Pain
RA
030217 neurology & neurosurgery
Zdroj: BMC Musculoskeletal Disorders
ISSN: 1471-2474
Popis: Background Despite numerous options for treating back pain and the increasing healthcare resources devoted to this problem, the prevalence and impact of back pain-related disability has not improved. It is now recognized that psychosocial factors, as well as physical factors, are important predictors of poor outcomes for back pain. A promising new approach that matches treatments to the physical and psychosocial obstacles to recovery, the STarT Back risk stratification approach, improved patients’ physical function while reducing costs of care in the United Kingdom (UK). This trial evaluates implementation of this strategy in a United States (US) healthcare setting. Methods Six large primary care clinics in an integrated healthcare system in Washington State were block-randomized, three to receive an intensive quality improvement intervention for back pain and three to serve as controls for secular trends. The intervention included 6 one-hour training sessions for physicians, 5 days of training for physical therapists, individualized and group coaching of clinicians, and integration of the STarT Back tool into the electronic health record. This prognostic tool uses 9 questions to categorize patients at low, medium or high risk of persistent disabling pain with recommendations about evidence-based treatment options appropriate for each subgroup. Patients at least 18 years of age, receiving primary care for non-specific low back pain, were invited to provide data 1–3 weeks after their primary care visit and follow-up data 2 months and 6 months (primary endpoint) later. The primary outcomes are back-related physical function and pain severity. Using an intention to treat approach, intervention effects on patient outcomes will be estimated by comparing mean changes at the 2 and 6 month follow-up between the pre- and post-implementation periods. The inclusion of control clinics permits adjustment for secular trends. Differences in change scores by intervention group and time period will be estimated using linear mixed models with random effects. Secondary outcomes include healthcare utilization and adherence to clinical guidelines. Discussion This trial will provide the first randomized trial evidence of the clinical effectiveness of implementing risk stratification with matched treatment options for low back pain in a United States health care delivery system. Trial registration NCT02286141. Registered November 5, 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1219-0) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
načítá se...