Stratified care for back pain implemented in general practice improves patient disability outcomes without increasing healthcare costs, shows a recent UK study.
The study looked at 922 patients with comparable baseline characteristics and low back pain. Researchers prospectively compared separate patient cohorts in a pre-intervention phase (6 months of usual care, n=368) and a post-intervention phase (12 months of stratified care, n=554). Stratified care entailed use of a risk stratification tool to classify patients into groups at low, medium, or high risk for persistent disability as measured by the Roland-Morris Disability Questionnaire scores, with a six-month change in disability as the primary outcome.
At six months follow-up, stratified care had a small but significant benefit relative to usual care. The mean change in the Roland-Morris Disability Questionnaire score was 0.7, with a large, clinically important change in the high risk group of 2.3. Mean time off work was 50% shorter (4 vs 8 days). Stratified care was also associated with an average saving of £34 per patient
The researchers recommended wider implementation of stratified care, noting that it ‘leads to significant improvements in patient disability outcomes and a halving in time off work, without increasing health care costs’.