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
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.
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
The stratified approach also appeared to be more cost-effective
as compared to the non-stratified approach.
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.