Article

OBJECTIVE: To evaluate whether current Dutch primary care clinicians offer
tailored treatment to patients with low back pain (LBP) or neck pain (NP)
according to their risk stratification, based on the Keele STarT (Subgroup
Targeted Treatment) Back-Screening Tool (SBT). DESIGN: Prospective cohort study
with 3-month follow-up. SETTING: Primary care. PARTICIPANTS: General
practitioners (GPs) and physiotherapists included patients (N=284) with
nonspecific LBP, NP, or both. INTERVENTIONS: Patients completed a baseline
questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up
measurement was conducted after 3 months to determine recovery (using Global
Perceived Effect Scale), pain (using Numeric Pain Rating Scale), and function
(using Roland Disability Questionnaire or Neck Disability Index). A questionnaire
was sent to the GPs and physiotherapists to evaluate the provided treatment. MAIN
OUTCOME MEASURES: Prevalence of patients' risk profile and clinicians' applied
care, and the percentage of patients with persisting disability at follow-up. A
distinction was made between patients receiving the recommended treatment and
those receiving the nonrecommended treatment. RESULTS: In total, 12 GPs and 33
physiotherapists included patients. After 3 months, we analyzed 184 patients with
LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low
risk for persisting disability, 38.0% were at medium risk, and 9.8% were at high
risk. Overall, 24.5% of the patients with LBP received a low-risk treatment
approach, 73.5% a medium-risk, and 2.0% a high-risk treatment approach. The
specific agreement between the risk profile and the received treatment for
patients with LBP was poor for the low-risk and high-risk patients (21.1% and
10.0%, respectively), and fair for medium-risk patients (51.4%). In the NP group,
58.0% of the patients were at low risk for persisting disability, 37.0% were at
medium risk, and 5.0% were at high risk. Only 6.1% of the patients with NP
received the low-risk treatment approach. The medium-risk treatment approach was
offered the most (90.8%), and the high-risk approach was applied in only 3.1% of
the patients. The specific agreement between the risk profile and received
treatment for patients with NP was poor for low-risk and medium-risk patients
(6.3% and 48.0%, respectively); agreement for high-risk patients could not be
calculated. CONCLUSIONS: Current Dutch primary care for patients with nonspecific
LBP, NP, or both does not correspond to the recommended stratified-care approach
based on the SBT, as most patients receive medium-risk treatment. Most low-risk
patients are overtreated, and most high-risk patients are undertreated. Although
the stratified-care approach has not yet been validated in Dutch primary care,
these results indicate there may be substantial room for improvement.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS