FOTO Rehab Outcomes Blog

Comparing Stratified Care with Usual Care for People Who Have Low Back Pain

Written by Selena Horner | Jan 23, 2017 11:00:00 AM


 Health care is in need of ways to improve the current care provided. As you saw in a previous post on health care spending, neck and back pain consume a lot of dollars. The STarT Back Screening Questionnaire is gaining attention globally. This means that treating individuals who have low back pain is globally expensive. It also means health care providers are growing in their understanding: not every person who has low back pain needs to be worked up with diagnostic testing. As it becomes more and more common to consider psychosocial factors, patients will begin to change their expectations. Right now, patients expect and demand the diagnostic testing because they are under the false belief that more is better. As health care providers begin to really listen to patients, trust their clinical judgment and depend less on unnecessary diagnostic testing, cost of care will substantially be reduced and hopefully outcomes of care will be better.

One day the photo above may not be what seems to be the standard for what happens when someone experiences low back pain. Here's a quick view of the abstract. 

Comparison of a Stratified Group Intervention (STarT Back) With Usual Group Care in Patients With Low Back Pain: A Nonrandomized Controlled Trial.




A nonrandomized controlled trial.


This study aims to explore the effectiveness of group-based stratified care in primary care.


Stratified care based on psychosocial screening (STarT Back) has demonstrated greater clinical and cost-effectiveness in patients with low back pain. However, low back pain interventions are often delivered in groups and evaluating this system of care in a group setting is important.


Patients were recruited from 60 general practices and linked physiotherapy services. A new group stratified intervention was compared with a historical nonstratified control group. Patients stratified as low, medium and high risk were offered risk-matched group care. Consenting participants completed self-report measures of functional disability (primary outcome measure), pain, psychological distress, and beliefs. The historical control received a generic group intervention. Analysis was by intention to treat.


In total, 251 patients in the new stratified intervention and 332 in the historical control were included in the primary analysis at 12 weeks. The mean age of patients was 43 ± 10.98 years. Overall adjusted mean changes in the RMDQ scores were higher in the stratified intervention than in the control arm at 12-week follow-up (P = 0.028). Exploring the risk groups, individually the high-risk stratified group, demonstrated better outcome over the controls (P = 0.031). The medium-risk stratified intervention demonstrated equally good outcomes (P = 0.125), and low-risk stratified patients, despite less intervention, did as well as the historical controls (P = 0.993).


Stratified care delivered in a group setting demonstrated superior outcomes in the high-risk patients, and equally good outcomes for the medium and low-risk groups. This model, embedded in primary care, provides an early and effective model of chronic disease management and adds another dimension to the utility of the STarT Back system of care.

Spine (Phila Pa 1976). 2016 Apr;41(8):645-52. doi: 10.1097/BRS.0000000000001305.