Abstract
Objective
To evaluate whether current Dutch primary care clinicians offer tailored treatment
to patients with low back pain (LBP) or neck pain (NP) according to their risk stratification,
based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT).
Design
Prospective cohort study with 3-month follow-up.
Setting
Primary care.
Participants
General practitioners (GPs) and physiotherapists included patients (N=284) with nonspecific
LBP, NP, or both.
Interventions
Patients completed a baseline questionnaire, including the Dutch SBT, for either LBP
or NP. A follow-up measurement was conducted after 3 months to determine recovery
(using Global Perceived Effect Scale), pain (using Numeric Pain Rating Scale), and
function (using Roland Disability Questionnaire or Neck Disability Index). A questionnaire
was sent to the GPs and physiotherapists to evaluate the provided treatment.
Main Outcome Measures
Prevalence of patients' risk profile and clinicians' applied care, and the percentage
of patients with persisting disability at follow-up. A distinction was made between
patients receiving the recommended treatment and those receiving the nonrecommended
treatment.
Results
In total, 12 GPs and 33 physiotherapists included patients. After 3 months, we analyzed
184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients
were at low risk for persisting disability, 38.0% were at medium risk, and 9.8% were
at high risk. Overall, 24.5% of the patients with LBP received a low-risk treatment
approach, 73.5% a medium-risk, and 2.0% a high-risk treatment approach. The specific
agreement between the risk profile and the received treatment for patients with LBP
was poor for the low-risk and high-risk patients (21.1% and 10.0%, respectively),
and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients
were at low risk for persisting disability, 37.0% were at medium risk, and 5.0% were
at high risk. Only 6.1% of the patients with NP received the low-risk treatment approach.
The medium-risk treatment approach was offered the most (90.8%), and the high-risk
approach was applied in only 3.1% of the patients. The specific agreement between
the risk profile and received treatment for patients with NP was poor for low-risk
and medium-risk patients (6.3% and 48.0%, respectively); agreement for high-risk patients
could not be calculated.
Conclusions
Current Dutch primary care for patients with nonspecific LBP, NP, or both does not
correspond to the recommended stratified-care approach based on the SBT, as most patients
receive medium-risk treatment. Most low-risk patients are overtreated, and most high-risk
patients are undertreated. Although the stratified-care approach has not yet been
validated in Dutch primary care, these results indicate there may be substantial room
for improvement.
Keywords
List of abbreviations:
GP (general practitioner), LBP (low back pain), NDI (Neck Disability Index), NP (neck pain), RDQ (Roland Disability Questionnaire), SBT (STarT Back-Screening Tool)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 11, 2017
Footnotes
Supported by CZ Healthcare Insurance Company and the Dutch Arthritis Association.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
