Effectiveness of a classification-based approach to low back pain in primary care - a benchmarking controlled trial

• Published in: Journal of rehabilitation medicine Vol. 56; p. jrm28321
• Main Authors: Simula, Anna Sofia, Malmivaara, Antti, Booth, Neill, Karppinen, Jaro
• Format: Journal Article
• Language: English
• Published: Sweden MJS Publishing, on behalf of the Foundation for Rehabilitation Information 20-04-2024; Medical Journals Sweden
• Subjects: Benchmarking; classification; Humans; low back pain; Low Back Pain - therapy; Original; Pain Measurement; patient education; primary care; Primary Health Care; Sick Leave; Treatment Outcome; primary care; benchmarking; classification; low back pain; patient education; stratified care
• ISSN: 1651-2081; 1650-1977; 1651-2081
• DOI: 10.2340/jrm.v56.28321

The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care.
A benchmarking controlled trial design was used.
Three primary healthcare areas and 654 low back pain patients with or without sciatica.
Classification-based care (using the STarT Back Tool) was implemented using organizational-, healthcare professional-, and patient-level interventions. The primary outcome was change in Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF-20) from baseline to 12 months.
No difference was found between the intervention and control in change in PROMIS PF-20 over the 12-month follow-up (mean difference 0.33 confidence interval -2.27 to 2.9, p = 0.473). Low back pain-related healthcare use, imaging, and sick leave days were significantly lower in the intervention group. Reduction in intensity of low back pain appeared to be already achieved at the 3-month follow-up (mean difference -1.3, confidence interval -2.1 to -0.5) in the intervention group, while in the control group the same level of reduction was observed at 12 months (mean difference 0.7, confidence interval -0.2 to 1.5, treatment*time p = 0.003).  Conclusion: Although classification-based care did not appear to influence physical functioning, more rapid reductions in pain intensity and reductions in healthcare use and sick leave days were observed in the intervention group.