Research Review: Clinical and Cost Effectiveness of Stratified vs Non-Stratified Primary Care of Low Back Pain | Modern Manual Therapy Blog

Research Review: Clinical and Cost Effectiveness of Stratified vs Non-Stratified Primary Care of Low Back Pain


Nxt Gen PT Evidence:
In 2011, an article in Lancet (Hill JC 2011) compared the clinical effectiveness and cost-effectiveness of stratified primary care with current non-stratified practice for the care of LBP.
A 2:1 randomization divided 851 individuals, who presented with LBP, into either an intervention or control group, respectively. Care was then stratified by risk as determined on the STarT LBP Tool. Below are the following subgroups:
Low Risk (3 or less on total STarT score) patients had a 30-minute assessment and initial treatment with advice focusing on promotion of appropriate levels of activity, including return to work, as well as given a pamphlet highlighting local exercise venues and self-help groups. In addition, these individuals they were shown a video, Get Back Active, and given the Back Book.
Medium Risk (4 or more on total STarT, with 3 or less on questions 5-9) patients were also given the same initial session and then referred for standardized physiotherapy to address symptoms and function.
High Risk (4 or more on total STarT, with 4 or more on questions 5-9) patients were also given the same initial session but referred for psychologically informed physiotherapy to address physical symptoms and function, while also addressing psychosocial obstacles.
Overall, the results of this study indicated that stratified management of patients with LBP lead to improved efficiency of care, better outcomes and reduced costs. Significant improvements in secondary measures were also noted.




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