Abstract
A new randomised controlled trial of intervention in low back pain has been described
recently. In this trial, a screening and targeted approach was found to be more effective
and cost-effective than current best practice. Nested within the intervention arm
were three different interventions targeting patients identified as ‘low’, ‘medium’
or ‘high’ risk dependent on the presence of (mainly) psychosocial risk factors. In
this paper, the development and content of the STarT Back trial's ‘high-risk’ intervention
is described. It offers a systematic approach, termed ‘psychologically informed practice’,
to the integration of physical and psychological approaches to treatment for the management
of people with low back pain by physiotherapists. The term ‘disability’ is used to
refer to self-reported pain-associated functional limitations, and ‘psychological’
is used to refer to the beliefs/expectations, emotional responses and behavioural
responses associated with low back pain.
Keywords
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References
Savingy P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, et al. Low back pain: early management of persistent non-specific low back pain. Full guideline. London: National Institute of Clinical Evidence; 2010. Available at: http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf.(last accessed 10.03.10).
- Comparison of physical treatments versus a brief pain management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice.Lancet. 2005; 365: 2024-2030
- Psychological therapies for the management of chronic pain (excluding headache) in adults.Cochrane Library. 2006; 4
- Psychosocial interventions for low back pain in primary care: lessons learned from recent trials.Spine. 2008; 33: 81-89
- Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.Lancet. 2010; 375: 916-923
- A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol.BMC Musculoskel Disord. 2008; 9: 58
Hill J, DGT Whitehurst, Lewis M, Bryan S, Dunn KM, Foster NE et al. A randomised controlled trial and economic evaluation of stratified primary care management for low back pain compared with current best practice: The STarT Back trial [ISRCTN37113406]. Lancet.(in press).
- IMPaCT Back Study Team. IMPaCT Back study protocol. Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective population-based sequential comparison.BMC Musculoskel Disord. 2010; 11: 186
- A primary care back pain screening tool: identifying patient subgroups for initial treatment.Arth Rheum. 2008; 59: 632-641
- A new clinical model for the treatment of low back pain.Spine. 1987; 12: 622-634
- Risk identification and screening.in: Main C.J. Sullivan M.J.L. Watson P.J. Pain management: practical applications of the biopsychosocial perspective in clinical and occupational settings. Churchill Livingstone Elsevier, Edinburgh2008: 97-134
Main CJ, George SZ. Psychosocial influences on low back pain – future directions in practice and research. Phys Ther, 91, 820-824.
- Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.Clin J Pain. 1998; 14: 209-215
- Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables.J Pain. 2007; 8: 67-74
- Identifying subgroups of patients with acute/subacute ‘nonspecific’ low back pain: results of a randomized clinical trial.Spine. 2006; 31: 623-631
- An examination of the reliability of a classification algorithm for subgrouping patients with low back pain.Spine. 2006; 31: 77-82
- Subgrouping low back pain: a comparison of the STarT Back Tool with the Orebro Musculoskeletal Pain Screening Questionnaire.Eur J Pain. 2010; 14: 83-89
- Comparing the STarT Back Screening Tool's subgroup allocation of individual patients with that of independent clinical experts.Clin J Pain. 2010; 26: 783-787
- Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program.Clin J Pain. 2003; 19: 97-104
- Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Results of a cluster-randomised clinical trial in general practice.BMJ. 2005; 331: 84-90
- Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course?.J Eval Clin Pract. 2009; 15: 724-732
- The implementation of occupational health guidelines principles for reducing sickness absence due to musculoskeletal disorders.Occup Med. 2006; 56: 237-242
- How important are back beliefs and expectations for satisfactory recovery from back pain?.Best Pract Clin Rheum. 2010; 24: 205-217
- Addressing patient beliefs in the consultation.Best Pract Clin Rheum. 2010; 24: 219-225
- A psychosocial risk factor-targeted intervention for the prevention of chronic pain and disability following whiplash injury.Phys Ther. 2006; 86: 8-18
Sanders T, Foster NE, Sowden G, Ong BE. Changing professional attitudes through a new system for managing back pain: the case of physiotherapy; Sociology of Health and Illness. In Press.
Sowden G, Hill JC, Konstantinou K, Khanna M, Main CJ, Salmon P, et al. Subgrouping for targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281); in preparation Family Practice. In Press.
Article Info
Publication History
Published online: June 13, 2011
Identification
Copyright
© 2011 Chartered Society of Physiotherapy. Published by Elsevier Inc. All rights reserved.
