THU0362 THE IMPACT OF A REFERRAL ALGORITHM FOR AXIAL SPONDYLOARTHRITIS: A FOUR MONTH FOLLOW-UP OF PATIENT REPORTED OUTCOMES

Abstract

Background A substantial amount of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs).1 As a result, several referral strategies have been developed to help physicians identify patients at risk for axSpA within the large group of CLBP patients.2 Most referral strategies were developed in secondary care patients. The only referral strategy that was developed and validated in primary low back patients is the CaFaSpA strategy.3 An essential step before implementing referral strategies in daily clinical practice is the execution of an impact analysis.4 Objectives The purpose of this study is to assess the impact of using a referral strategy on patient outcomes in young primary care patients with CLBP at risk for axSPA. Methods A clustered randomized controlled trial was performed in a primary care setting (ClinicalTrials.gov Identifier: NCT01944163). Each cluster contained the general practices from a single primary care practice and their included patients. Clusters were randomized to either the intervention (use of CaFaSpA referral strategy) or the control group (usual care). Primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and 4 months. Secondary outcome was axSpA diagnosis made by a rheumatologist. A linear mixed-effects model was used to analyze mean change in RMDQ score. Results In total 679 patients were included within 93 GP clusters. Sixty-four percent of our study population were female and mean age was 36 years. Median RMDQ score at baseline was 8 (IQR 4-12) in both groups. Compared to baseline, mean RMDQ score decreased by 0.74 points at 4 months (intervention) and by 0.46 points (control) (Fig. 1). This decrease did not significantly differ between groups (p=0.50). Eight percent of the finally referred patients in the intervention group, received an axSPA diagnosis (8%) from the rheumatologist. The median RMDQ among patients who visited the rheumatologist decreased from 8 to 5 after 4 month. This was not statistically significant (p-value=0.17). Conclusion Although the CaFaSpA referral strategy did not have an early impact on disability caused by CLBP, it can be used as a screening strategy for GPs to identify axSpA patients.