Background Back pain is a major public health problem. To improve patient outcomes, sub-grouping patients into more homogenous groups for targeted treatment has been advocated (Foster 2011). The STarTBack screening tool (Hill 2008) subgroups patients based on risk of persisting symptoms (low, medium, high risk).
Objectives To determine if patients subgrouped as ‘High Risk’ (STarTBack tool) and managed accordingly using targeted treatment in a physiotherapy group setting, achieve better outcomes with regard to pain and disability compared to a retrospective matched control group who received a standard 10 week exercise/education intervention regardless of STarTBack risk category.
Methods Patients referred from primary care centres were stratified into: (i) one off exercise/education session (Low Risk). (ii) 10 week exercise/education intervention (Medium Risk) or (iii) 10 week Cognitive Behavioural Therapy/exercise intervention (High Risk) groups, the ‘High Risk’ intervention being the new Intervention. Disability was measured using the Roland Morris Disability Questionnaire (RMDQ) (0-24) and pain using the Visual Analogue Scale [VAS 0-10]. Follow up occurred at 3 months. Ethical approval was obtained. All data were entered into PASW 18. Differences between targeted and standard treatment outcomes were analysed and effect sizes analysed using Cohen d calculations.
Results In total 39 matched patients were assigned to the ‘High Risk’ new intervention and retrospective standard control. There was no statistically significant difference between the groups at baseline with regard to disability and pain. (p>0.05). At 3 month follow up, a large effect size was found in the ‘High Risk’ stratified group (cohen’s d 1.14) compared with control group where a moderate effect size (Cohen d 0.51) was found. Moderate effect sizes for changes in VAS were found in both intervention (Cohen’s d 0.58) and control data (Cohen’s d 0.56). Neither variable reached statistical significance(p>0.05)
Conclusions Preliminary pilot results demonstrate that a stratified approach for ‘High Risk’ patients has a greater effect than standard exercise/education intervention. Longer-term follow up with a larger patient cohort may demonstrate even greater benefits.
References Foster, N, Hill J, Hay E. (a) Sub-grouping patients with low back pain in primary care : Are we getting any better at it? Manual Therapy 2011; 16:3-8.
Hill Jonathan, Dunn K, Lewis M, Mullis R, Main C, Foster N, Hay E. A primary care Back Pain Screening Tool: Identifying patient subgroups for initial treatment. Arthritis and Rheumatism. 2008; 59: 5: 632 -641.
Acknowledgements Funded by an unrestricted educational grant from Pfizer Healthcare Ireland
Disclosure of Interest None Declared