Bier J.1, Sandee-Geurts J.2, Ostelo R.3,4, Koes B.1, Verhagen A.1
1Erasmus MC, General Health, Rotterdam, Netherlands, 2VU University Amsterdam, Faculty of Human Movements Sciences, Amsterdam, Netherlands, 3VU University Amsterdam, Epidemiology and Biostatistics, Amsterdam, Netherlands, 4VU University Amsterdam, Health Sciences, Faculty of Earth and Life Sciences, Amsterdam, Netherlands
Background: LBP is the primary cause and NP the fourth of disability worldwide. The STarT (Subgroup Targeted Treatment) Back Screening Tool (SBT) is a tool to allocate primary care patients with LBP into subgroups: low-, medium-, or high-risk for persisting disability. This allocation aims to apply the appropriate stratified care for patients at-risk for persistent LBP in order to prevent it. The tool had been translated en validated in Dutch to fit patients with LBP and NP.
Purpose: We aimed to evaluate whether current Dutch primary care clinicians treated patients with low back or neck pain with low or high-risk for persistent complaint different than those with medium-risk. The risk stratification was based on the STarT Back Screening Tool.
Methods: General practitioners and physiotherapists included patients with LBP or NP. Patients completed a baseline questionnaire including the SBT. A follow-up measurement was conducted after 3 months to determine recovery (using the global perceived effect scale), pain (numeric pain rating scale) and function (Roland Disability Questionnaire or the Neck Disability Index). Furthermore a questionnaire was sent to the clinician about treatment decisions. Two researchers determined independently whether the provided treatment corresponded with the recommended stratified care based on the SBT. Subsequently we calculated the specific agreement between the risk profile at baseline and the clinicians applied care.
Results: In total 184 patients with low back pain and 100 patients with neck pain were included. Out of the patients with LBP, 52.2% had low-risk, 38.0% medium-risk and 9.8% high-risk for persisting disability and 24.5% of the LBP patients received a low-risk treatment approach, 73.5% a medium-risk and 2.0% a high-risk treatment approach. The specific agreement between risk profile and received treatment was poor for low-risk (21.1%) and high-risk (10.0%) it was fair for medium-risk (51.4%). For patients with neck pain 58.0% of the 100 patients had low-risk for persisting disability, 37.0% medium-risk and 5.0% high-risk. Only 6.1% of the patient with neck pain received the low-risk treatment. Medium-risk treatment approach was given the most (90.8%) and the high-risk approach in only 3.1% of the patients. The specific agreement between risk profile and received treatment for neck pain patients was poor for low and medium-risk (6.3% and 48.0%) and no agreement for high-risk.
Conclusion(s): The current Dutch primary care for patients with LBP or NP does not correspond with the advised stratified care approach based on the SBT. Over half of the patients were over treated. Although the stratified care approach has not been validated in Dutch primary care yet, these results indicate that there may be substantial room for improvement.
Implications: We found differences between usual care and the advised stratified care. Usual care focuses mainly on the therapy advised for medium-risk patients. Educating the clinicians in the STarT back approach, mainly for the low and high-risk group, is conditional for the STarT back approach to be effective in reducing pain, function and sick leave in The Netherlands.
Funding acknowledgements: CZ healthcare and the Dutch Arthritis association
Topic: Musculoskeletal: spine
Ethics approval: Medical ethics committee of the ErasmusMC, Rotterdam, the Netherlands. Number MEC-2014-256
All authors, affiliations and abstracts have been published as submitted.
