A Stratified Approach for Managing Patients With Low Back Pain in Primary Care (SPLIT Program): A Before-and-After Study

• Published in: Annals of family medicine Vol. 22; no. 3; pp. 195 - 202
• Main Authors: Gomes, Luís Antunes, Fernandes, Rita, Caeiro, Carmen, Henriques, Ana Rita, de Sousa, Rute Dinis, Branco, Jaime C, Pimentel-Santos, Fernando, Moniz, Rubina, Vicente, Lilia, Canhão, Helena, Rodrigues, Ana Maria, Cruz, Eduardo Brazete
• Format: Journal Article
• Language: English
• Published: United States Annals of Family Medicine 01-05-2024; American Academy of Family Physicians
• Subjects: Adult; Aged; Backache; Care and treatment; Comparative analysis; Controlled Before-After Studies; Diagnosis; Disability; Disability Evaluation; Evaluation; Female; Health aspects; Humans; Low back pain; Low Back Pain - therapy; Male; Management; Medical research; Medicine, Experimental; Middle Aged; Original Research; Pain; Pain Measurement; Physical therapy; Physical Therapy Modalities; Portugal; Primary Health Care; Prospective Studies; Quality of Life; Therapeutics, Physiological; Portugal; controlled before-after study; primary health care; family practice; physical therapy; low back pain; stratified care
• ISSN: 1544-1709; 1544-1717; 1544-1717
• DOI: 10.1370/afm.3104

To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care.
We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points).
We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability (ß, -2.94; 95% CI, -3.63 to -2.24;
≤ .001), pain (ß, -0.88; 95% CI, -1.18 to -0.57;
≤ .001), perceived effect of treatment (ß, 1.40; 95% CI, 0.97 to 1.82;
≤ .001), and health-related quality of life (ß, 0.11; 95% CI, 0.08 to 0.14;
≤ .001) compared with UC.
Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC.