A stratified approach to the management of back pain in primary care could provide a more effective alternative to conventional one-size-fits-all care, suggests the first study to test the idea.
The stratified model uses a screening questionnaire to allocate people with low back pain to three groups based on their estimated risk of persistent disability -low, medium, or high risk - with treatment then tailored accordingly.
UK researchers from Keele University in Staffordshire randomised 851 patients to either stratified care or usual care based on current best practice of advice, exercise and manual therapy delivered by physiotherapists.
At both four months and 12 months, patients in the intervention group showed a significant improvement in disability scores compared with patients in the control group.
They were also more likely to report reduced fear, less depression, and better general health.
The authors say: “For many years, the potential for targeting treatment has been emphasised as a research priority for back pain.
“The results of this trial provide the first evidence that a stratified management approach to target the provision of primary care significantly improves patient outcomes and is associated with substantial economic benefits compared with current best practice.”
They added: “The findings of this study represent an important advance in primary care management of back pain.”