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

IF 4.4 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Family Medicine Pub Date : 2024-05-01 DOI:10.1370/afm.3104

Luís Antunes Gomes, Rita Fernandes, Carmen Caeiro, Ana Rita Henriques, Rute Dinis de Sousa, Jaime C Branco, Fernando Pimentel-Santos, Rubina Moniz, Lilia Vicente, Helena Canhão, Ana Maria Rodrigues, Eduardo Brazete Cruz

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引用次数: 0

Abstract

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 (ß, -2.94; 95% CI, -3.63 to -2.24; P ≤ .001), pain (ß, -0.88; 95% CI, -1.18 to -0.57; P ≤ .001), perceived effect of treatment (ß, 1.40; 95% CI, 0.97 to 1.82; P ≤ .001), and health-related quality of life (ß, 0.11; 95% CI, 0.08 to 0.14; P ≤ .001) compared with UC.

Conclusions: Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC.

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基层医疗机构管理腰背痛患者的分层方法（SPLIT 计划）：前后对比研究

目的：确定腰背痛分层初级护理（SPLIT 计划）在减少初级护理中腰背痛患者背部相关残疾方面的效果：我们进行了一项前后对比研究。我们比较了在葡萄牙 7 个初级医疗单位招募的两组连续、独立的腰背痛患者的健康相关结果。第一项前瞻性队列研究以常规护理（UC）为特征，收集了2018年2月至9月的数据。第二项研究是在实施 SPLIT 计划时进行的，收集了 2018 年 11 月至 2021 年 10 月的数据。在两个队列之间，物理治疗师接受了实施 SPLIT 计划的培训，该计划使用 STarT 背部筛查工具对患者进行分类，以便进行匹配治疗。我们比较了与背部相关的残疾（罗兰-莫里斯残疾问卷，0-24分）、疼痛（数字疼痛评分量表，0-10分）、治疗效果感知（全球效果感知量表，-5至+5分）和健康相关的生活质量（EuroQoL 5维3级指数，0-1分）：我们共招募了 447 名患者：结果：我们共招募了 447 名患者：115 名 UC 队列（大部分接受药物治疗）和 332 名 SPLIT 队列（全部接受物理治疗干预计划）。在为期 6 个月的研究期间，参加 SPLIT 计划的患者在背部相关残疾（ß，-2.94；95% CI，-3.63 至 -2.24；P ≤ .001）、疼痛（ß，-0.88；95% CI，-1.18至-0.57；P≤ .001）、治疗效果感知（ß，1.40；95% CI，0.97至1.82；P≤ .001）和健康相关生活质量（ß，0.11；95% CI，0.08至0.14；P≤ .001）：结论：与接受UC治疗的患者相比，接受SPLIT项目治疗腰椎间盘突出症的患者在健康相关结果方面获益更大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Family Medicine 医学-医学：内科

CiteScore

3.70

自引率

4.50%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Annals of Family Medicine is a peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve.