Schröder Karin, Öberg Birgitta, Enthoven Paul, Hedevik Henrik, Fors Maria, Abbott Allan
Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, S-581 83 Linköping, Sweden.
Department of Activity and Health in Linköping, Linköping University, S-581 83 Linköping, Sweden.
J Clin Med. 2021 Mar 16;10(6):1230. doi: 10.3390/jcm10061230.
Low back pain (LBP) occurs in all ages and first-line treatment by physiotherapists is common. The main aim of the current study was to evaluate the effectiveness of implementing a best practice model of care for LBP (intervention group-BetterBack☺ MoC) compared to routine physiotherapy care (control group) regarding longitudinal patient reported outcomes. The BetterBack☺ MoC contains clinical guideline recommendations and support tools to facilitate clinician adherence to guidelines. A secondary exploratory aim was to compare patient outcomes based on the fidelity of fulfilling a clinical practice quality index regarding physiotherapist care. A stepped cluster randomized design nested patients with LBP in the three clusters which were allocated to control ( = 203) or intervention ( = 264). Patient reported measures were collected at baseline, 3, 6 and 12 months and analyzed with mixed model regression. The primary outcome was between-group changes from baseline to 3 months for pain intensity and disability. Implementation of the BetterBack☺ MoC did not show any between-group differences in the primary outcomes compared with routine care. However, the intervention group showed significantly higher satisfaction at 3 months and clinically meaningful greater improvement in LBP illness perception at 3 months and quality of life at 3 and 6 months but not in patient enablement and global impression of change compared with the control group. Physiotherapists' care that adhered to all clinical practice quality indices resulted in an improvement of most patient reported outcomes with a clinically meaningful greater improved LBP illness perception at 3 months and quality of life at 3 and 6 months, significantly greater improvement in LBP illness perception, pain and satisfaction at 3 and 6 months and significantly better enablement at all time points as well as better global improvement outcomes at 3 months compared with non-adherent care. This highlights the importance of clinical guideline based primary care for improving patient reported LBP outcomes.
腰痛（LBP）在各个年龄段均有发生，物理治疗师进行的一线治疗很常见。本研究的主要目的是评估与常规物理治疗护理（对照组）相比，实施腰痛最佳实践护理模式（干预组 - BetterBack☺ 护理模式）在纵向患者报告结局方面的有效性。BetterBack☺ 护理模式包含临床指南建议和支持工具，以促进临床医生遵守指南。次要探索性目的是根据物理治疗师护理在满足临床实践质量指标方面的依从性来比较患者结局。采用阶梯式整群随机设计，将腰痛患者嵌套在三个整群中，这些整群被分配到对照组（n = 203）或干预组（n = 264）。在基线、3个月、6个月和12个月收集患者报告的测量数据，并采用混合模型回归进行分析。主要结局是从基线到3个月疼痛强度和残疾程度的组间变化。与常规护理相比，BetterBack☺ 护理模式的实施在主要结局方面未显示出任何组间差异。然而，与对照组相比，干预组在3个月时满意度显著更高，在3个月时腰痛疾病认知方面有临床意义的更大改善，在3个月和6个月时生活质量有临床意义的更大改善，但在患者赋能和总体变化印象方面没有差异。遵循所有临床实践质量指标的物理治疗师护理导致大多数患者报告结局得到改善，在3个月时腰痛疾病认知有临床意义的更大改善，在3个月和6个月时生活质量有临床意义的更大改善，在3个月和6个月时腰痛疾病认知、疼痛和满意度有显著更大改善，在所有时间点赋能显著更好，在3个月时总体改善结局更好，与不遵循护理相比。这凸显了基于临床指南的初级护理对改善患者报告的腰痛结局的重要性。
