Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
Center for Community Health and Evaluation, Seattle, WA, USA.
J Gen Intern Med. 2018 Aug;33(8):1324-1336. doi: 10.1007/s11606-018-4468-9. Epub 2018 May 22.
The STarT Back strategy for categorizing and treating patients with low back pain (LBP) improved patients' function while reducing costs in England.
This trial evaluated the effect of implementing an adaptation of this approach in a US setting.
The Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) trial was a pragmatic cluster randomized trial with a pre-intervention baseline period. Six primary care clinics were pair randomized, three to training in the STarT Back strategy and three to serve as controls.
Adults receiving primary care for non-specific LBP were invited to provide data 2 weeks after their primary care visit and follow-up data 2 and 6 months (primary endpoint) later.
The STarT Back risk-stratification strategy matches treatments for LBP to physical and psychosocial obstacles to recovery using patient-reported data (the STarT Back Tool) to categorize patients' risk of persistent disabling pain. Primary care clinicians in the intervention clinics attended six didactic sessions to improve their understanding LBP management and received in-person training in the use of the tool that had been incorporated into the electronic health record (EHR). Physical therapists received 5 days of intensive training. Control clinics received no training.
Primary outcomes were back-related physical function and pain severity. Intervention effects were estimated by comparing mean changes in patient outcomes after 2 and 6 months between intervention and control clinics. Differences in change scores by trial arm and time period were estimated using linear mixed effect models. Secondary outcomes included healthcare utilization.
Although clinicians used the tool for about half of their patients, they did not change the treatments they recommended. The intervention had no significant effect on patient outcomes or healthcare use.
A resource-intensive intervention to support stratified care for LBP in a US healthcare setting had no effect on patient outcomes or healthcare use.
National Clinical Trial Number NCT02286141.
针对慢性腰痛患者进行分类和治疗的 STarT 后背策略（STarT Back strategy）在英国改善了患者的功能，同时降低了成本。
本试验评估了在 美国环境下实施该方法改编版的效果。
匹配消费者医疗保健需求的适当治疗（MATCH）试验是一项具有干预前基线期的实用集群随机试验。将 6 家初级保健诊所进行配对随机分组，3 家诊所接受 STarT 后背策略培训，3 家诊所作为对照组。
接受非特异性慢性腰痛初级保健的成年人被邀请在初级保健就诊后 2 周提供数据，并在 2 和 6 个月后（主要终点）进行随访数据。
STarT 后背风险分层策略使用患者报告数据（STarT 后背工具）来评估患者持续致残性疼痛的风险，将治疗方法与身体和心理社会康复障碍相匹配。干预诊所的初级保健临床医生参加了 6 次理论课程，以提高他们对腰痛管理的理解，并接受了该工具使用方面的现场培训，该工具已整合到电子健康记录（EHR）中。物理治疗师接受了 5 天的强化培训。对照组诊所未接受培训。
主要结果是与背部相关的身体功能和疼痛严重程度。通过比较干预和对照组诊所患者在 2 个月和 6 个月后结局的平均变化，来评估干预效果。使用线性混合效应模型估计试验臂和时间段对变化评分的差异。次要结局包括医疗保健利用率。
尽管临床医生为大约一半的患者使用了该工具，但他们没有改变他们推荐的治疗方法。该干预对患者结局或医疗保健使用没有显著影响。
在 美国医疗保健环境中，一项资源密集型的支持慢性腰痛分层护理的干预措施对患者结局或医疗保健使用没有影响。
美国国立卫生研究院临床试验编号 NCT02286141。
