271. A biopsychosocial approach in the management of chronic low back pain: 2-year outcomes

Abstract

BACKGROUND CONTEXT Back pain is a pervasive public health problem with two-thirds of the population experiencing it at some point in their lives and associated with significant costs for both treatment and associated loss of productivity. When pain is persistent, traditional single service approaches to treating back pain may be insufficient, as they do not address the psychosocial factors which frequently impact an individual's pain experience. PURPOSE This study aims to present effect of multidisciplinary program using patient reported outcomes measures in this approach to chronic low back pain (CLBP) management. STUDY DESIGN/SETTING The Cleveland Clinic operates an interdisciplinary pain program to care for patients with CLBP, called Back on TREK (BoT). PATIENT SAMPLE First 168 patients to graduate in BoT over a 2-year period (2016-2018). OUTCOME MEASURES Patient-reported outcomes were systematically collected at the point of care through a patient-entered data collection platform which integrates data into the electronic medical record and is immediately available to care providers. Questionnaires include the STarT Back Screening Tool, Oswestry Disasbility Index (ODI), The Patient Health Questionnaire-9 (PHQ-9) depression screen, and several Patient-Reported Outcome Measurement Information System (PROMIS) v1.0 scales, anxiety, satisfaction with social roles, fatigue, pain intensity, physical function and sleep disturbance. Reduction in ODI of 10 or more points is considered to indicate clinically meaningful improvement. PROMIS is a set of self-report measures that assess an individual physical, mental and social health. A change of 5 or more points in PROMIS scores is considered to reflect a meaningful difference. METHODS This retrospective study reviewed all graduated participants with CLBP enrolled in the BoT. RESULTS Analysis was performed on the outcomes of 168 patients completing the BoT program. At the time of graduation, these patients had significant improvement in pain-related disability as measured by MDQ compared to baseline assessments. Clinically significant changes across multiple functional quality of life metrics were also observed, including fatigue, physical function, pain interference and social role satisfaction. In addition, nearly half of the participants demonstrated clinically significant changes in depression and anxiety. CONCLUSIONS The Back on TREK program demonstrates promising 2-year outcomes and supports the basis for creating a standardized way of providing treatment for patients with chronic back pain based in a biopsychosocial treatment paradigm. The process behind the development of this program further emphasizes the value of multispecialty inputs in program development to ensure thorough assessment, intervention and evaluation protocols. The program has since expanded from a pilot status and holds future goals of reaching more individuals with chronic low back pain. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.