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

BMC Musculoskeletal Disorders

Study Protocol

Gail Sowden¹  Diane Piekara²  Katherine Talbert Estlin²  Pam Rock²  Clarissa Hsu³  Andrea Cook⁴  Rob Wellman⁴  Dan Cherkin⁴  Rene Hawkes⁴  Sarah C. Evers⁴  Karen Sherman⁴  Benjamin Balderson⁴  Martin D. Levine⁵  Nadine E. Foster⁶  John Yeoman⁷  Georgie Brewer⁷  Mark Jensen⁷  Anne-Marie LaPorte⁷  Jonathan C. Hill⁸ 

[1] Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele, UK;IMPACT Service, Stoke-on-Trent, UK;Group Health Cooperative, Seattle, USA;Group Health Research Institute, Center for Community Health and Evaluation, Seattle, USA;Group Health Research Institute, Seattle, USA;Iora Health, Shoreline, USA;NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK;Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele, UK;Patient Partner, Seattle, USA;Primary Care & Health Sciences, Keele University, Keele, UK;

关键词: Back pain;    Risk-stratification;    STarT back;    Quality improvement;    Guidelines;    Primary care;    Physical therapy;    Patient outcomes;    Utilization;    Systems;   

DOI  :  10.1186/s12891-016-1219-0

 received in 2016-07-09, accepted in 2016-08-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsSix 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.DiscussionThis 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 registrationNCT02286141. Registered November 5, 2014.

【 授权许可】

CC BY   
© The Author(s). 2016