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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_2 | Pages 3 - 3
1 Feb 2018
Cherkin D Hill J Sowden G Foster N
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Purpose & Background

The STarT Back risk-stratification approach uses the STarT Back Tool to categorise patients with low back pain (LBP) at low, medium or high-risk of persistent disabling pain, in order to match treatments. The MATCH trial (NCT02286141) evaluated the effect of implementing an adaptation of this approach in a United States healthcare setting.

Methods

This was a pragmatic cluster randomised trial with a pre-intervention baseline period. Six primary care clinics were pair-randomised, three to an intensive stratified care quality improvement intervention and three as controls. LBP patients were invited to provide outcomes two weeks after their primary care visit, and two and six months later. Primary outcomes were physical function (RMDQ) and pain (0–10 NRS), and secondary outcomes including healthcare use and treatments provided received. Analysis was intention-to-treat.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 3 - 3
1 May 2017
Wynne-Jones G Artus M Bishop A Lawton S Lewis M Main C Sowden G Wathall S Burton A van der Windt D Hay E
Full Access

Introduction

Early intervention is advocated to prevent long-term work absence due to musculoskeletal (MSK) pain. The SWAP trial tested whether adding a vocational advice (VA) service to best current care led to fewer days work absence over 4 months.

Methods

The SWAP trial was a cluster randomised controlled trial in 6 general practices, 3 randomised to best current care (control), 3 randomised to best current care and the VA service (intervention). Patients were ≥18 years, absent from work ≤6 months or struggling at work due to MSK pain. Primary outcome was number of days absent over 4 months. Exploratory subgroup analyses examined whether the effect was larger for patients with spinal pain compared to other MSK pain.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_4 | Pages 28 - 28
1 Jan 2013
Hill J Whitehurst D Lewis M Bryan S Dunn K Foster N Konstantinou K Main C Mason E Somerville S Sowden G Vohora K Hay E
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Background

One untested back pain treatment model is to stratify management depending on prognosis (low, medium or high-risk). This 2-arm RCT investigated: (i) overall clinical and cost-effectiveness of stratified primary care (intervention), versus non-stratified current best practice (control); and (ii) whether low-risk patients had non-inferior outcomes, and medium/high-risk groups had superior outcomes.

Methods

1573 adults with back pain (+/− radiculopathy) consulting at 10 general practices in England responded to invitations to attend an assessment clinic, at which 851 eligible participants were randomised (intervention n=568; control n=283). Primary outcome using intention-to-treat analysis was the difference in change in the Roland-Morris Disability Questionnaire (RMDQ) score at 12 months. Secondary outcomes included 4-month RMDQ change between arms overall, and at risk-group level at both time-points. The economic evaluation estimated incremental quality-adjusted life years (QALYs) and back pain-related health care costs.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 490 - 490
1 Aug 2008
Hill J Konstantinou K Mason E Sowden G Vohora C Dunn K Main C Hay E
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Background: Last year we presented the STarT Back Tool, which is validated for use in Primary Care. It subgroups patients into 3 categories (high, medium and low risk) on the basis of modifiable risk factors for chronicity. We are now piloting the feasibility of using the tool as part of a new approach to sub-grouping and targeting back pain in primary care.

Methods: The physiotherapy interventions for the 3 subgroups were developed after reviewing the literature, current guidelines, the content of existing targeted treatment programmes, and convening workshops with internationally recognised experts. Both the intervention training modules, and the targeted treatments were piloted. Consecutive back pain consulters were identified using GP electronic Read Codes (weekly downloads) and invited to attend the study’s back pain clinic. Consenting patients completed a baseline questionnaire and were classified by the tool into one of 3 sub-groups.

Results: 60 patients were recruited. 50 patients were allocated to receive treatment according to their subgroup allocation and 10 patients (control group) received a triage physiotherapy assessment (usual care) to decide if they needed further physiotherapy treatment. Primary outcomes include the Roland Morris Disability Questionnaire and the Pain Catastrophising Scale. Three-month follow-up postal questionnaires are currently being administered and outcomes will be presented at the conference. Clinicians involved (GPs, and physiotherapists) will be interviewed to identify the feasibility of this approach.

Conclusions: Once feasibility is established we will take this developmental work forwards into the clinical trial arena to investigate whether this novel “sub-grouping for targeted treatment” approach provides a cost effective way of reducing long-term risk of chronic disability in patients consulting their GP with back pain.