Karppinen Jaro, Simula Anna Sofia, Holopainen Riikka, Lausmaa Mikko, Remes Jouko, Paukkunen Maija, Ussing Kasper, Booth Neill, Ryynänen Katja, Koski Tomi, Abbott Allan, Öberg Birgitta, Linton Steven J, Smith Anne, O'Sullivan Peter, Malmivaara Antti
Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland.
Finnish Institute of Occupational Health Oulu Finland.
Health Sci Rep. 2021 Mar 4;4(1):e251. doi: 10.1002/hsr2.251. eCollection 2021 Mar.
To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care.
The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18-65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant-level data) and the participating units' registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model.
The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.
为防止腰痛（LBP）发展为长期致残状况，临床指南提倡进行早期评估、风险筛查和针对性干预。职业健康服务机构推荐以指南为导向的生物心理社会筛查以及个体化评估与管理。然而，尚不清楚培训数量有限的医疗保健专业人员是否能改善管理流程。本研究的主要目的是调查生物心理社会实践模式培训在减少残疾方面是否有效。此外，我们旨在评估与常规医疗护理相比，该培训干预措施对健康经济的影响。
职业健康服务单位将通过双臂整群随机对照设计分配到培训组或对照组。对职业物理治疗师和医生的培训将包括使用STarT Back工具和Örebro肌肉骨骼疼痛筛查问卷简版评估与疼痛相关的心理社会因素，使用基于证据的患者教育手册作为腰痛管理的一部分，以及根据风险分层对腰痛进行针对性的个体化管理。对照组将不接受培训。研究人群将包括年龄在18 - 65岁的非特异性腰痛患者。主要结局是患者报告的从基线到12个月的奥斯威斯残疾指数。通过估计随时间的组间差异，我们旨在评估与常规医疗护理相比培训干预措施的有效性，并使用个体患者的医疗保健记录（参与者层面的数据）和参与单位的登记册（整群层面的数据）进行经济评估。此外，通过访谈和问卷调查，我们将探讨医疗保健专业人员对实践模式采用情况、实施障碍和促进因素的看法。
对职业健康服务中以指南为导向的腰痛生物心理社会管理培训进行评估是合理的，因为腰痛在工作残疾方面构成了巨大负担。
