Article

The effectiveness of risk stratification for low back pain (LBP)
management has not been demonstrated in outpatient physical therapy settings.
The purposes of this study were: (1) to assess implementation of a
stratified care approach for LBP management by evaluating short-term treatment
effects and (2) to determine feasibility of conducting a larger-scale study.
DESIGN: This was a 2-phase, preliminary study. METHODS: In phase 1, clinicians
were randomly assigned to receive standard (n=6) or stratified care (n=6)
training. Stratified care training included 8 hours of content focusing on
psychologically informed practice. Changes in LBP attitudes and beliefs were
assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists
(PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale
(HC-PAIRS). In phase 2, clinicians receiving the stratified care training were
instructed to incorporate those strategies in their practice and 4-week patient
outcomes were collected using a numerical pain rating scale (NPRS), and the
Oswestry Disability Index (ODI). Study feasibility was assessed to identify
potential barriers for completion of a larger-scale study. RESULTS: In phase 1,
minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care
clinicians (Cohen d=0.00-0.28). Decreased biomedical (-4.5+/-2.5 points, d=1.08)
and increased biopsychosocial (+5.5+/-2.0 points, d=2.86) treatment orientations
were observed for stratified care clinicians, with these changes sustained 6
months later on the PABS-PT. In phase 2, patients receiving stratified care
(n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence
interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1,
13.6; d=0.76) scores compared with patients receiving standard physical therapy
care (n=33). LIMITATIONS: In phase 2, treatment was not randomly assigned, and
therapist adherence to treatment recommendations was not monitored. This study
was not adequately powered to conduct subgroup analyses. CONCLUSIONS: In physical
therapy settings, biomedical orientation can be modified, and risk-stratified
care for LBP can be effectively implemented. Findings from this study can be used
for planning of larger studies.
CI - (c) 2015 American Physical Therapy Association.

Langue : ANGLAIS