IMPLEMENTATION OF TARGETED TREATMENT FOR LOW BACK PAIN PATIENTS IN PRIMARY CARE: A PROSPECTIVE POPULATION-BASED SEQUENTIAL COMPARISON

Background and purposeThe STarT Back trial demonstrated benefits from a stratified primary care model that targets low back pain (LBP) treatment according to patient prognosis (low-, medium-, or high-risk). The current IMPaCT Back study implemented this approach in everyday primary care to investigate; i) changes in GPs' and physiotherapists' attitudes, confidence and behaviours, ii) patients' clinical outcomes, and iii) cost-effectiveness.MethodThis quality improvement study involved 5 GP practices (65 GPs and 34 physiotherapists) with before and after implementation cohorts of consecutive LBP consulters using an intention to treat analysis to compare patient data. Phase 1: Usual care data collection from clinicians and patients (pre-implementation). Phase 2: Introduction of prognostic screening and targeted treatment including a minimal GP intervention (low-risk group), systematic referral to physiotherapy (medium-risk group) and to psychologically informed physiotherapy (high-risk group). Phase 3: Post...