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Erschienen in: Journal of General Internal Medicine 8/2018

22.05.2018 | Original Research

Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care

verfasst von: Dan Cherkin, PhD, Benjamin Balderson, PhD, Rob Wellman, MS, Clarissa Hsu, PhD, Karen J. Sherman, PhD, Sarah C. Evers, MPH, Rene Hawkes, BS, Andrea Cook, PhD, Martin D. Levine, MD, Diane Piekara, PT, Pam Rock, PT, Katherine Talbert Estlin, MD, Georgie Brewer, Mark Jensen, Anne-Marie LaPorte, John Yeoman, Gail Sowden, MSc, Jonathan C. Hill, PhD, Nadine E. Foster, DPhil

Erschienen in: Journal of General Internal Medicine | Ausgabe 8/2018

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Abstract

Background

The STarT Back strategy for categorizing and treating patients with low back pain (LBP) improved patients’ function while reducing costs in England.

Objective

This trial evaluated the effect of implementing an adaptation of this approach in a US setting.

Design

The Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) trial was a pragmatic cluster randomized trial with a pre-intervention baseline period. Six primary care clinics were pair randomized, three to training in the STarT Back strategy and three to serve as controls.

Participants

Adults receiving primary care for non-specific LBP were invited to provide data 2 weeks after their primary care visit and follow-up data 2 and 6 months (primary endpoint) later.

Interventions

The STarT Back risk-stratification strategy matches treatments for LBP to physical and psychosocial obstacles to recovery using patient-reported data (the STarT Back Tool) to categorize patients’ risk of persistent disabling pain. Primary care clinicians in the intervention clinics attended six didactic sessions to improve their understanding LBP management and received in-person training in the use of the tool that had been incorporated into the electronic health record (EHR). Physical therapists received 5 days of intensive training. Control clinics received no training.

Main measures

Primary outcomes were back-related physical function and pain severity. Intervention effects were estimated by comparing mean changes in patient outcomes after 2 and 6 months between intervention and control clinics. Differences in change scores by trial arm and time period were estimated using linear mixed effect models. Secondary outcomes included healthcare utilization.

Key Results

Although clinicians used the tool for about half of their patients, they did not change the treatments they recommended. The intervention had no significant effect on patient outcomes or healthcare use.

Conclusions

A resource-intensive intervention to support stratified care for LBP in a US healthcare setting had no effect on patient outcomes or healthcare use.

Trial Registration

National Clinical Trial Number NCT02286141.
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Metadaten
Titel
Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care
verfasst von
Dan Cherkin, PhD
Benjamin Balderson, PhD
Rob Wellman, MS
Clarissa Hsu, PhD
Karen J. Sherman, PhD
Sarah C. Evers, MPH
Rene Hawkes, BS
Andrea Cook, PhD
Martin D. Levine, MD
Diane Piekara, PT
Pam Rock, PT
Katherine Talbert Estlin, MD
Georgie Brewer
Mark Jensen
Anne-Marie LaPorte
John Yeoman
Gail Sowden, MSc
Jonathan C. Hill, PhD
Nadine E. Foster, DPhil
Publikationsdatum
22.05.2018
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 8/2018
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-018-4468-9

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