A new study published in The Lancet’s Online First has found that targeting back care according to the individual person’s needs is far more effective can currently used generic physiotherapy methods.

The STarT Back trial study led by Professor Elaine Hay, looked at whether a stratified approach to managing back pain would be cheaper and more effective than the current practice of offering the same format of treatment to all sufferers. Previous studies have shown that different treatments, including exercise and “cognitive behavioural therapy” (CBT) work well compared to standard care, but so far there has been little evidence to show which treatments would be of most help to which patients.

The results will be significant for the NHS, as it is reported that approximately 49% of the UK population suffer from back pain lasting for up to 24 hours at some point in every year. Figures from Backcare, the back pain charity, state that 80% of people will experience back pain at some time in our lives, which in actual terms costs the NHS annually more than £1 billion.

Current treatment guidelines leave up to 80% of those who see their GP still reporting pain or disability a year after their initial appointment.

The study was carried out at the Arthritis Research UK Primary Care Centre at Keele University and examined 851 adults with back pain from 10 GP practices across England. An intervention group of 568 patients received stratified care, whilst he remaining 283 in the control group received advice, exercise and manual therapy, following current best practice. The patients were followed up after four months and again at 12 months.

Patients receiving stratified care were screened and placed into three groups based on risk. The low-risk patients had one intervention, which included advice on activity and exercise, and on returning to work. They also received information on local self-help groups, and a video on getting active and a book on back care. People in the medium-risk group had the same initial session and further physiotherapy-led sessions. Those in the high-risk group were referred for psychologically-informed physiotherapy.

Along with an improvement in the levels of back pain-related disability amongst patients, those receiving stratified care also reported other benefits including superior physical and emotional functioning, lower levels of pain, fewer days off work and satisfaction with their treatment. At the 12-month check-up, members of this group were also more likely to report that they were less fearful, less depressed, and in better general health.

An implementation study with GP’s has also been run which has demonstrated that this approach may feasibly work in practice. It has been reported that where GP’s do engage clearly, they find this approach a helpful tool for early decision-making about whether or not to refer. The study indicated that physiotherapists too are keen to use this method, and find it useful to work out the priority of the patient in order to determining how best to go about treatment.

Dr Jonathan Hill, one of the leading academics behind the study says that results of the study were promising. “We weren’t over-treating the people who had a very good prognosis, and that had a beneficial effect for them. And yet we were doing a good job at getting those who really needed treatment through into the services that were going to help them.”

In additional to enhancing the patient experience, the stratified intervention also delivered a saving in costs of £34.39 per patient.

Original Source Saga

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