Abstract
Background
A randomised 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.
Methods
The study was a two-armed RCT. Danish primary care patients with LBP were randomised 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 utilisation and quality-adjusted life years.
Results
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 to 0.14, p = .70).
Conclusions
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.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2RAQ2tJ
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