Stratified health care for low back pain using the STarT Back approach: holy grail or doomed to fail?

IF 5.9 1区 医学 Q1 ANESTHESIOLOGY
PAIN® Pub Date : 2024-12-01 Epub Date: 2024-07-18 DOI:10.1097/j.pain.0000000000003319
Peter Croft, Jonathan C Hill, Nadine E Foster, Kate M Dunn, Danielle A van der Windt
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引用次数: 0

Abstract

Abstract: There have been at least 7 separate randomised controlled trials published between 2011 and 2023 that have examined primary care for nonspecific low back pain informed by the STarT Back approach to stratified care based on risk prediction, compared with care not informed by this approach. The results, across 4 countries, have been contrasting-some demonstrating effectiveness and/or efficiency of this approach, others finding no benefits over comparison interventions. This review considers possible explanations for the differences, particularly whether this is related to poor predictive performance of the STarT Back risk-prediction tool or to variable degrees of success in implementing the whole STarT Back approach (subgrouping and matching treatments to predicted risk of poor outcomes) in different healthcare systems. The review concludes that although there is room for improving and expanding the predictive value of the STarT Back tool, its performance in allocating individuals to their appropriate risk categories cannot alone explain the variation in results of the trials to date. Rather, the learning thus far suggests that challenges in implementing stratified care in clinical practice and in changing professional practice largely explain the contrasting trial results. The review makes recommendations for future research, including greater focus on studying facilitators of implementation of stratified care and developing better treatments for patients with nonspecific low back pain at high risk of poor outcomes.

使用 STarT Back 方法对腰背痛进行分层保健:圣杯还是注定失败?
摘要:2011 年至 2023 年间,至少有 7 项独立的随机对照试验对非特异性腰背痛的初级治疗进行了研究,这些试验采用了 STarT Back 方法,根据风险预测进行分层治疗,并与未采用该方法的治疗进行了比较。4 个国家的研究结果形成了鲜明对比--一些研究结果表明了这种方法的有效性和/或效率,而另一些研究结果则发现与比较干预措施相比没有任何益处。本综述考虑了造成这种差异的可能原因,特别是这是否与 STarT Back 风险预测工具的预测性能不佳有关,还是与在不同医疗保健系统中实施整个 STarT Back 方法(根据预测的不良后果风险进行分组和匹配治疗)的成功程度不同有关。综述得出的结论是,尽管 STarT Back 工具的预测价值还有改进和扩展的空间,但其在将个体分配到适当风险类别方面的表现并不能单独解释迄今为止试验结果的差异。相反,迄今为止的研究结果表明,在临床实践中实施分层护理和改变专业实践方面的挑战在很大程度上解释了试验结果的反差。综述为今后的研究提出了建议,包括更加注重研究实施分层护理的促进因素,以及为非特异性腰背痛高风险患者开发更好的治疗方法。
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
PAIN®
PAIN® 医学-临床神经学
CiteScore
12.50
自引率
8.10%
发文量
242
审稿时长
9 months
期刊介绍: PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
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