Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial.
Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial.
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DOI：
10.1002/ejp.1818
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Christiansen DH
中科院分区：
文献类型：
--
作者：
Morsø L;Olsen Rose K;Schiøttz-Christensen B;Sowden G;Søndergaard J;Christiansen DH
一项分层护理的随机对照试验（RCT）证明了英国初级保健中腰痛（LBP）患者的上级临床结局和成本效益。这是在欧洲进行的第一项研究，在最初的英国研究之外，研究分层护理与目前对非特异性LBP患者的实践相比的临床疗效和成本效益。该研究是一项双臂RCT。丹麦LBP初级保健患者随机分层护理（n = 169）或目前的做法（n = 164）。3个月和12个月随访时的主要结局为罗兰莫里斯残疾问卷（RDMQ）、患者报告的总体变化和下班时间。次要结局包括疼痛强度、患者满意度、医疗资源利用和质量调整生命年。意向治疗分析发现，3个月（0.5，95% CI-1.8至0.9）或12个月（0.4，-2.1至1.3）时RMDQ评分无组间差异。在3个月和12个月时，两组在下班时间或次要结局方面没有发现总体差异。分层护理干预导致治疗次数显著减少（3.5 [SD 3.1] vs. 4.5 [3.5]），总医疗费用（€）显著降低（13.4 [529] vs. 228 [830]，p = .002）。成本-效果无差异（0.09，0.05 - 0.13 vs. 0.10，0.07-0.14，p = 0.70）。接受分层治疗的非特异性LBP患者与接受当前实践的患者之间的临床结局无显著差异。但是，如果在丹麦的初级保健中实施，分层护理可能会降低总的医疗保健费用。最近的循证临床指南建议根据风险状况对腰痛进行分层护理。该研究是欧洲首次广泛复制STarT背部试验。因此，这项研究增加了知识体系，评估分层护理在初级保健中对腰痛的有效性，并深入了解分层对临床实践的影响。
A randomized controlled trial (RCT) of stratified care demonstrated superior clinical outcomes and cost‐effectiveness for low back pain (LBP) patients in UK primary care. This is the first study in Europe, outside of the original UK study, to investigate the clinical efficacy and cost‐effectiveness of stratified care compared with current practice for patients with non‐specific LBP. The study was a two‐armed RCT. Danish primary care patients with LBP were randomized to stratified care (n = 169) or current practice (n = 164). Primary outcomes at 3‐ and 12‐months' follow‐up were Roland Morris Disability Questionnaire (RDMQ), patient‐reported global change and time off work. Secondary outcomes included pain intensity, patient satisfaction, healthcare resource utilization and quality‐adjusted life years. Intention‐to‐treat analyses found no between‐group difference in RMDQ scores at 3 months (0.5, 95% CI −1.8 to 0.9) or 12 months (0.4, −2.1 to 1.3). No overall differences were found between the arms at 3 and 12 months with respect to time off work or secondary outcomes. Stratified care intervention resulted in significantly fewer treatment sessions (3.5 [SD 3.1] vs. 4.5 [3.5]) and significantly lower total healthcare costs (€) (13.4 [529] vs. 228 [830], p = .002). There was no difference in cost‐effectiveness (0.09, 0.05 to 0.13 vs. 0.10, 0.07–0.14, p = .70). There was no significant difference in clinical outcomes between patients with non‐specific LBP receiving stratified care and those receiving current practice. However, stratified care may reduce total healthcare costs if implemented in Danish primary care. Stratified care for low back pain based on risk profile is recommended by recent evidence based clinical guidelines. This study is the first broad replication of the STarT Back Trial in Europe. Therefore, the study adds to the body of knowledge evaluating the effectiveness of stratified care for low back pain in primary care, and provides insight into the effects of stratification on clinical practice.
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影响因子：
3.3
作者：
Brooks, R
通讯作者：
Brooks, R
影响因子：
1.9
作者：
Field, Jonathan;Newell, Dave
通讯作者：
Newell, Dave
影响因子：
3.2
作者：
Beneciuk, Jason M.;Bishop, Mark D.;George, Steven Z.
通讯作者：
George, Steven Z.
影响因子：
3.2
作者：
Beneciuk, Jason M.;George, Steven Z.
通讯作者：
George, Steven Z.
DOI：
10.1002/art.23563
发表时间：
2008-05-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Hill, Jonathan C.;Dunn, Kate M.;Hay, Elaine M.
通讯作者：
Hay, Elaine M.