Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Fam Pract. 2012 Feb;29(1):50-62. doi: 10.1093/fampra/cmr037. Epub 2011 Jun 27.
The IMPaCT Back study (IMplementation to improve Patient Care through Targeted treatment for Back pain) is a quality improvement study which aims to investigate the effects of introducing and supporting a subgrouping for targeted treatment system for patients with low back pain (LBP) in primary care. This paper details the subgrouping for targeted treatment system and the clinical training and mentoring programmes aimed at equipping clinicians to deliver it. THE SUBGROUPING AND TARGETED TREATMENT SYSTEM: This system differs from 'one-size fits all' usual practice as it suggests that first contact health care practitioners should systematically allocate LBP patients to one of the three subgroups according to key modifiable prognostic indicators for chronicity. Patients in each subgroup (those at low, medium or high risk of chronicity) are then managed according to a targeted treatment system of increasing complexity. THE SUBGROUPING TOOLS: Subgrouping tools help guide clinical decision-making about treatment and onward referral. Two subgrouping tools have been used in the IMPaCT Back study, a 9-item version used by participating physiotherapists and a 6-item version used by GPs. The targeted treatments. The targeted treatments include a minimal intervention delivered by GPs (for those patients at low risk of poor outcome) or referral to primary care physiotherapists who can apply physiotherapy approaches to addressing pain and disability (for those at medium risk) and additional cognitive-behavioural approaches to help address psychological and social obstacles to recovery (for those at high risk). THE TRAINING PACKAGES: Building on previous interventions for other pilot studies and randomized trials, we have developed and delivered clinical training and support programmes for GPs and physiotherapists.
This paper describes in detail the IMPaCT Back study's subgrouping for targeted treatment system and the training and mentoring packages aimed at equipping clinicians to deliver it, within the IMPaCT Back study.
ISRCTN55174281.
IMPACT Back 研究（通过针对腰痛的靶向治疗改善患者护理的实施）是一项质量改进研究，旨在调查在初级保健中引入和支持针对腰痛（LBP）患者的靶向治疗系统的效果。本文详细介绍了靶向治疗系统的分组和旨在为临床医生提供实施该系统所需的临床培训和指导计划。分组和靶向治疗系统：该系统与“一刀切”的常规做法不同，因为它建议一线医疗保健从业者应根据慢性疾病的关键可改变预后指标，系统地将 LBP 患者分配到三个亚组之一。然后，根据针对特定治疗系统的复杂性，对每个亚组（慢性风险低、中或高的患者）进行管理。分组工具：分组工具有助于指导有关治疗和转介的临床决策。IMPACT Back 研究中使用了两种分组工具，一种是参与物理治疗师使用的 9 项分组工具，另一种是全科医生使用的 6 项分组工具。靶向治疗：靶向治疗包括全科医生提供的最低干预措施（对于那些预后不良风险低的患者）或转介至初级保健物理治疗师，他们可以应用物理治疗方法来解决疼痛和残疾（对于那些中风险的患者）和额外的认知行为方法，以帮助解决康复过程中的心理和社会障碍（对于高风险的患者）。培训包：在先前为其他试点研究和随机试验开发的干预措施的基础上，我们为全科医生和物理治疗师制定并提供了临床培训和支持计划，以在 IMPACT Back 研究中实施。讨论：本文详细描述了 IMPACT Back 研究的靶向治疗分组系统以及培训和指导计划，旨在为临床医生提供实施该系统的能力，这是在 IMPACT Back 研究中进行的。研究注册：ISRCTN55174281。
