Effectiveness of a classification-based approach to low back pain in primary care – a benchmarking controlled trial

Abstract

Objective: The aim of this study was to assess the effectiveness of classification-based approach for low back pain care in Finnish primary care. Design: A benchmarking controlled trial design was used. Subjects/patients: Three primary healthcare areas and 654 low back pain patients with or without sciatica. Methods: 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. Results: 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.