Strategy that categorizes back pain patients by risk may save time, money

Sep 30 2011
Separating patients with back pain by prognosis and treating them accordingly may benefit them in terms of recovery time and money spent, suggesting that the current "one-size-fits-all" approach to these patients may need an overhaul, according to new research.

About 80 percent of Americans will experience back pain at some point in their lives. It is considered the most common neurological disorder, second only to headaches. More than 28 percent of adults aged 18 years or older reported having lower back pain some time in the three months prior to being surveyed, according to the Centers for Disease Control and Prevention. It is a leading cause of lost productivity in terms of time taken off from work, and poses a financial burden to the healthcare system.

In the UK, as few as 20 percent of patients consulting their general practitioner for lower back pain had resolved their symptoms a year later. Because there is some disagreement in the guidelines dictating which individuals should be referred to further treatment, researchers decided to try a new model in approaching these patients. Their experiment asked study participants to fill out a questionnaire known as the STarT Back Screening Tool, which divided patients according to their prognosis: low risk, medium risk or high risk.

The control group of patients received the standard treatment, in which they consulted a physiotherapist that had no knowledge of how people scored on the STarT tool. The physiotherapist thus decided upon their treatment based on individual judgment. However, the other group of patients saw physiotherapists who referred to the STarT score. Based on risk assessment, these subjects received clinical advice, a referral to physiotherapy sessions or special therapy sessions that also addressed psychosocial issues.

Results, published Sept. 29 in The Lancet, showed that patients who received treatment based on their risk prognosis improved faster in terms of pain relief, emotional well-being, time off work and other factors. Furthermore, consultations for the control subjects revealed that they were more likely to be referred to treatment that was unnecessary, or conversely, not offered the option for further treatment that actually may have benefited them.

Ultimately, this study may have implications for targeted care in lower back pain.