Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of General Medicine, Wellbeing services county of South Savo (ELOISA), Mikkeli, Finland.
Finnish Institute for Health and Welfare, Helsinki, Finland; Orton Orthopaedic Hospital, Helsinki, Finland.
J Rehabil Med. 2024 Apr 20;56:jrm28321. doi: 10.2340/jrm.v56.28321.
The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care.
A benchmarking controlled trial design was used.
SUBJECTS/PATIENTS: Three primary healthcare areas and 654 low back pain patients with or without sciatica.
Classification-based care (using the STarT Back Tool) was implemented using organizational-, healthcare professional-, and patient-level interventions. The primary outcome was change in Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF-20) from baseline to 12 months.
No difference was found between the intervention and control in change in PROMIS PF-20 over the 12-month follow-up (mean difference 0.33 confidence interval -2.27 to 2.9, p = 0.473). Low back pain-related healthcare use, imaging, and sick leave days were significantly lower in the intervention group. Reduction in intensity of low back pain appeared to be already achieved at the 3-month follow-up (mean difference -1.3, confidence interval -2.1 to -0.5) in the intervention group, while in the control group the same level of reduction was observed at 12 months (mean difference 0.7, confidence interval -0.2 to 1.5, treatment*time p = 0.003). Conclusion: Although classification-based care did not appear to influence physical functioning, more rapid reductions in pain intensity and reductions in healthcare use and sick leave days were observed in the intervention group.
本研究旨在评估基于分类的腰痛治疗方法在芬兰初级保健中的效果。
采用基准对照试验设计。
受试者/患者：3 个初级保健区和 654 名腰痛伴或不伴坐骨神经痛的患者。
使用分类护理（使用 STarT 背部工具），实施组织、医疗保健专业人员和患者层面的干预措施。主要结局指标是从基线到 12 个月时患者报告的结局测量信息系统（PROMIS）物理功能（PROMIS PF-20）的变化。
在 12 个月的随访中，干预组与对照组在 PROMIS PF-20 变化方面没有差异（平均差异 0.33，置信区间-2.27 至 2.9，p=0.473）。干预组的腰痛相关医疗保健使用、影像学检查和病假天数显著降低。干预组在 3 个月随访时腰痛强度似乎已经降低（平均差异-1.3，置信区间-2.1 至-0.5），而对照组在 12 个月时观察到相同程度的降低（平均差异 0.7，置信区间-0.2 至 1.5，治疗*时间 p=0.003）。结论：虽然基于分类的护理似乎没有影响身体功能，但干预组观察到疼痛强度更快降低，医疗保健使用和病假天数减少。
