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

Authors :
Gomes, Luis Antunes
Fernandes, Rita
Caeiro, Carmen
Henriques, Ana Rita
Sousa, Rute Dinis de
Branco, Jaime C.
Pimentel-Santos, Fernando
Moniz, Rubina
Vicente, Lilia
Canhao, Helena
Rodrigues, Ana Maria
Cruz, Eduardo Brazete
Source :
Annals of Family Medicine. May-June 2024, Vol. 22 Issue 3, p195, 8 p.
Publication Year :
2024

Abstract

INTRODUCTION Low back pain (LBP) is a high-burden health problem worldwide, and its management represents a serious challenge for health systems. (1-4) The burden caused by LBP is mainly explained [...]<br />PURPOSE 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. METHODS 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). RESULTS 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 ([beta], -2.94; 95% CI, -3.63 to -2.24; P[less than or equal to].001), pain ([beta], -0.88; 95% CI, -1.18 to -0.57; P[less than or equal to].001), perceived effect of treatment ([beta], 1.40; 95% CI, 0.97 to 1.82; P[less than or equal to].001), and health-related quality of life ([beta], 0.11; 95% CI, 0.08 to 0.14; P[less than or equal to].001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC. https://doi.org/10.1370/afm.3104

Details

Language :
English
ISSN :
15441709
Volume :
22
Issue :
3
Database :
Gale General OneFile
Journal :
Annals of Family Medicine
Publication Type :
Academic Journal
Accession number :
edsgcl.797827437
Full Text :
https://doi.org/10.1370/afm.3104