Abstract
BackgroundPrior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. Hence this study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice.Methods/designThe study is a two-armed randomised controlled trial in primary care in the Regions of Southern and Central Denmark (2.5 million citizens). Patients with non-specific low back will be recruited by paticpating GPs. Patients are randomised to either (1) stratified care or (2) current practice at participating physiotherapy clinics. In the stratified care arm, the intervention is based on the patient’s STarT Back Tool classification and trained accordingly, whereas physiotherapists in the current pratice arm are blinded to the STarT score. Primary outcomes in the trial will be group differences in time off work, improvement in LBP disability measured by the Roland Morris Disability Questionnaire (RMDQ) and patient-reported global change. Secondary measures will be pain intensity, patient satisfaction, data on patient healthcare resource utilisation and quality-adjusted life year based on the EQ-5D-5L.DiscussionStratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. Thus, if effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain.Trial registrationClinicalTrials.gov, NCT02612467. Registered on 16 November 2015.
Highlights
Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice
Stratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. If effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain
The stratified care model resulted in a 50% reduction in low back pain (LBP)-related sickness absence and lower healthcare costs compared to current best practice [6]
Summary
Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. This study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice. Emerging evidence indicates that stratified care of low back pain (LBP) may result in better clinical outcome and reduced healthcare costs, compared to usual care [1]. The aim of this study is to evaluate the clinical effects and cost-effectiveness of a stratified care model in patients with NSLBP compared to current practice in a Danish primary healthcare setting
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