Can primary care for back and/or neck pain in the Netherlands benefit from stratification for risk groups according to the STarT Back Tool-classification?

Publication date: Available online 12 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jasper D. Bier, Janneke J.W. Sandee-Geurts, Raymond W.J.G. Ostelo, Bart W. Koes, Arianne P. Verhagen
ObjectiveTo evaluate whether current Dutch primary-care clinicians offer tailored treatment to patients with lower-back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT).DesignProspective cohort study with 3 month follow-upSettingPrimary careParticipantsGeneral practitioners (GPs) and physiotherapists (PTs) included patients with non-specific LBP and/or NP.InterventionsPatients 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 the Global Perceived Effect (GPE) scale), pain (using the Numeric Pain-Rating Scale (NPRS)) and function (using the Roland Disability Questionnaire (RDQ) or the Neck Disability Index (NDI)). A questionnaire was sent to the GPs and PTs to evaluate the provided treatment.Main outcome measuresPrevalence 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 advised treatment and those receiving the non-advised treatment.ResultsIn total, 12 GPs and 33 PTs 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 LBP patients 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 (respectively 21.1% and 10.0%), 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 NP patients was poor for low-risk and medium-risk patients (resp. 6.3% and 48.0%); agreement for high-risk patients could not be calculated.ConclusionCurrent Dutch primary care for patients with non-specific LBP and/or NP does not correspond to the advised stratified-care approach based on the SBT as the majority of patients receive medium risk treatment. The majority of "low-risk" patients are over-treated and the majority of "high-risk" patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate that there may be substantial room for improvement.



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