Back pain is a common symptom for which patients consult their primary care physician. Better treatment options of back pain at the primary health care level is likely to have long term benefits in reducing disability and improving work capacity.
The use of a stratified approach in the treatment of back pain has been suggested. Using this approach, patients are treated according to the likely outcome or prognosis of the condition. In this system of treatment, patients are categorized into low, medium and high risk groups depending on the likely prognosis, and are treated according to different modalities or pathways.
AdvertisementThe stratified approach will possibly ensure better and more effective treatment to all types of patients. If this practice is not followed, there could be unnecessary excessive treatment in the low-risk group patients, which could definitely spike up the cost of treatment. On the other hand, it could also result in lesser than required treatment in the medium and high-risk groups and consequently less relief of pain and more chances of suffering from disability.
In a recently published study, researchers compared two approaches to treatment of patients with back pain. The patients were divided into two groups - one in which a stratified approach to treatment was being followed, and the second, which was being treated by the non-stratified approach that is usually followed in clinical practice. The cost effectiveness of the two approaches was also studied.
A total of 851 patients with back pain were included in the study. Their mean age was 50 years and they did not suffer from any serious ailments.
The patients were randomly divided into two groups - an intervention group with a total of 568 patients where the stratified approach was followed, and the control group comprising of 283 patients.
The patients in the intervention group were divided according to the likely outcome for their condition. Accordingly, 221 patients were classified as low risk, 394 as medium risk and 236 as high risk. A baseline assessment was made at the first visit. The patients were treated according to treatments specially designed for the particular group. The control group was treated according to the best practices usually followed at the clinic. The effect of treatment was recorded using a questionnaire at the end of 4 and 12 months. The economic evaluation related to treatment was also carried out.
The results of the questionnaire at the end of 4 as well as 12 months indicated that patients treated via a stratified approach responded better to treatment. The patients who following the stratified treatment appeared to be more satisfied with treatment and took a fewer days off from work due to back pain.
The stratified approach also appeared to be more cost-effective as compared to the non-stratified approach.
The study thus suggests that using a stratified approach in primary care towards treating back pain does improve patient's clinical outcome. It is also cost-effective, and should be followed.