Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System

Key Points Question Is risk-stratified care more effective than usual care for patients with low back pain seeking care in the Military Health System? Findings In this randomized clinical trial of 270 adults with low back pain, the risk-stratified care approach did not result in superior scores on the Roland Morris Disability Questionnaire at 1 year compared with patients who received usual care. Meaning These findings suggest that clinicians seeing patients for low back pain in the Military Health System should be cautious about implementing this particular risk-stratified care treatment approach.

[1]  Jodi L. Young,et al.  Proposing six criteria to improve reproducibility of "usual care" interventions in back pain trials: a systematic review. , 2022, Journal of clinical epidemiology.

[2]  Alexander C. Ziedas,et al.  PROMIS Physical Function Instruments Compare Favorably to Legacy Patient Reported Outcome Measures in Spine Patients: A Systematic Review of the Literature. , 2021, The spine journal : official journal of the North American Spine Society.

[3]  J. Beierlein,et al.  NIH's Helping to End Addiction Long-termSM Initiative (NIH HEAL Initiative) Clinical Pain Management Common Data Element Program. , 2021, The journal of pain.

[4]  J. Søndergaard,et al.  Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial , 2021, European journal of pain.

[5]  S. George,et al.  Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. , 2021, Translational research : the journal of laboratory and clinical medicine.

[6]  Michael J. Schneider,et al.  Stratified care to prevent chronic low back pain in high-risk patients: The TARGET trial. A multi-site pragmatic cluster randomized trial , 2021, EClinicalMedicine.

[7]  P. Peduzzi,et al.  Adapting to disruption of research during the COVID-19 pandemic while testing nonpharmacological approaches to pain management. , 2020 .

[8]  P. Kent,et al.  Risk-stratified and stepped models of care for back pain and osteoarthritis: are we heading towards a common model? , 2020, Pain reports.

[9]  E. Bush,et al.  Measuring the impact of chronic low back pain on everyday functioning: content validity of the Roland Morris disability questionnaire , 2020, Journal of Patient-Reported Outcomes.

[10]  G. Collins,et al.  Global, regional, and national burden of other musculoskeletal disorders 1990-2017: results from the Global Burden of Disease Study 2017. , 2020, Rheumatology.

[11]  R. Buchbinder,et al.  The Lancet Series call to action to reduce low value care for low back pain: an update , 2020, Pain.

[12]  J. Fritz,et al.  Transforming low back pain care delivery in the United States. , 2020, Pain.

[13]  Michael J. Schneider,et al.  Targeted interventions to prevent transitioning from acute to chronic low back pain in high-risk patients: development and delivery of a pragmatic training course of psychologically informed physical therapy for the TARGET trial , 2019, Trials.

[14]  Martin D. Levine,et al.  Adaptation and Implementation of the STarT Back Risk Stratification Strategy in a US Health Care Organization: A Process Evaluation. , 2018, Pain medicine.

[15]  S. Linton,et al.  Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care. , 2018, Pain.

[16]  R. Horton,et al.  Low back pain: a major global challenge , 2018, The Lancet.

[17]  Andrea Cook,et al.  Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care , 2018, Journal of General Internal Medicine.

[18]  S. Lewis,et al.  Guidelines for the Content of Statistical Analysis Plans in Clinical Trials , 2017, JAMA.

[19]  S. George,et al.  Development of a Yellow Flag Assessment Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort. , 2016, The Journal of orthopaedic and sports physical therapy.

[20]  J. Wyatt,et al.  Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide , 2014, BMJ : British Medical Journal.

[21]  Shirley D Hon,et al.  Psychometric Properties of the PROMIS Physical Function Item Bank in Patients With Spinal Disorders , 2014, Spine.

[22]  P. Watson,et al.  Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's 'high-risk' intervention (StarT Back; ISRCTN 37113406). , 2012, Physiotherapy.

[23]  Ellen J. MacKenzie,et al.  Psychological distress mediates the effect of pain on function , 2011, PAIN.

[24]  William S Shaw,et al.  Impact of Psychological Factors in the Experience of Pain , 2011, Physical Therapy.

[25]  L. Macedo,et al.  Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire , 2011, European Spine Journal.

[26]  John D. Childs,et al.  Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention , 2005 .

[27]  J. Farrar,et al.  Core outcome measures for chronic pain clinical trials: IMMPACT recommendations , 2003, Pain.

[28]  M. Roland,et al.  The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. , 2000, Spine.

[29]  G. Devilly,et al.  Psychometric properties of the credibility/expectancy questionnaire. , 2000, Journal of behavior therapy and experimental psychiatry.

[30]  P. Shekelle,et al.  Low back pain. , 2012, The Journal of orthopaedic and sports physical therapy.

[31]  S. Bryan,et al.  Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial , 2011 .