The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP - a non randomised controlled trial

Hdl Handle:
http://hdl.handle.net/10147/306901
Title:
The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP - a non randomised controlled trial
Authors:
Murphy, Susan E; Blake, Catherine; Power, Camillus K; Fullen, Brona M
Citation:
BMC Musculoskeletal Disorders. 2013 Dec 05;14(1):342
Journal:
BMC musculoskeletal disorders
Issue Date:
5-Dec-2013
URI:
http://dx.doi.org/10.1186/1471-2474-14-342; http://hdl.handle.net/10147/306901
Abstract:
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.
Item Type:
Article
Language:
en
Keywords:
BACK PAIN; MUSCULOSKELETAL DISORDERS

Full metadata record

DC FieldValue Language
dc.contributor.authorMurphy, Susan Een_GB
dc.contributor.authorBlake, Catherineen_GB
dc.contributor.authorPower, Camillus Ken_GB
dc.contributor.authorFullen, Brona Men_GB
dc.date.accessioned2013-12-16T14:53:09Z-
dc.date.available2013-12-16T14:53:09Z-
dc.date.issued2013-12-05-
dc.identifier.citationBMC Musculoskeletal Disorders. 2013 Dec 05;14(1):342en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2474-14-342-
dc.identifier.urihttp://hdl.handle.net/10147/306901-
dc.description.abstractAbstract 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.-
dc.language.isoenen
dc.subjectBACK PAINen_GB
dc.subjectMUSCULOSKELETAL DISORDERSen_GB
dc.titleThe effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP - a non randomised controlled trialen_GB
dc.typeArticleen
dc.identifier.journalBMC musculoskeletal disordersen_GB
dc.language.rfc3066en-
dc.rights.holderSusan E Murphy et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2013-12-11T16:15:36Z-
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