Background and goal: Low back pain, or LBP, challenges health systems worldwide. To mitigate persistent disabling LBP, the implementation of a stratified approach in primary care has been suggested. This strategy involves aligning specific treatments with distinct patient subgroups.
The StarT Back trial demonstrates the effectiveness and cost effectiveness of the stratified approach for LBP using the StarT Back Screening Tool (SBST), which categorizes patients into low, medium, and high risk of developing persistent disabling pain. This approach suggests matched physical therapy treatments of increasing dosages and complexity according to risk subgroups. The goal of this study was to determine the effects of a stratified approach (SPLIT program) in reducing back-related disability of patients with LBP in primary care.
Study approach: Conducted with the Regional Health Administration of Lisbon and Tagus Valley, the study involved 7 health units of the Arrábida health center group. It enlisted 447 participants, using a before-and-after design with two sequential, independent patient groups. From February to September 2018, family physicians managed the initial group of 115 patients according to usual care, unaware of the SPLIT program.
The second phase involved training and mentoring primary care–based physical therapists (PT) in a structured program to potentiate the implementation of a stratified care approach, the SPLIT program. This phase included training PTs in assess.
