Objective: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice...Objective: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice. Design: Cluster randomised clinical trial. Setting: 60 general practitioners in 41 general practices. Participants: 314 patients with nonspecific low back pain of less than 12 weeks’duration, recruited by their general practitioner. Interventions: In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised. Main outcome measures: Functional disability (RolandMorris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks. Results: The dropout rate was 8%in the minimal intervention strategy group and 9%in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of followup in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain). Conclusion: This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual care.展开更多
Background: Recommendations for the management of low back pain in primary ca re emphasise the importance of recognising and addressing psychosocial factors a t an early stage. We compared the effectiveness of a brief...Background: Recommendations for the management of low back pain in primary ca re emphasise the importance of recognising and addressing psychosocial factors a t an early stage. We compared the effectiveness of a brief pain- management pro gramme with physiotherapy incorporating manual therapy for the reduction of disa bility at 12 months in patients consulting primary care with subacute low back p ain. Methods: For this pragmatic, multicentre, randomised clinical trial, eligib le participants consulted primary care with non- specific low back pain of less than 12 weeks’ duration. They were randomly assigned either a programme of pa in management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Ana lysis was by intention to treat. Findings: Of 544 patients assessed for eligibil ity, 402 were recruited (mean age 40.6 years) and 329 (82% )- reached 12- mon th follow- up. Mean disability scores were 13.8 (SD 4.8) for the pain- managem ent group and 13.3 (4.9) for the manual- therapy group. The mean decreases in d isability scores were 8.8 (6.4) and 8.8 (6.1) at 12 months (difference 0 [95% CI - 1.3 to 1.4], p=0.99), and median numbers of physiotherapy visits per patie nt were three (IQR one to five) and four (two to five), respectively (p=0.001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded. Interpretation: Brief pain management techniques delivered by appropri ately trained clinicians offer an alternative to physiotherapy incorporating man ual therapy and could provide a more efficient first- line approach for managem ent of non- specific subacute low back pain in primary care.展开更多
文摘Objective: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice. Design: Cluster randomised clinical trial. Setting: 60 general practitioners in 41 general practices. Participants: 314 patients with nonspecific low back pain of less than 12 weeks’duration, recruited by their general practitioner. Interventions: In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised. Main outcome measures: Functional disability (RolandMorris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks. Results: The dropout rate was 8%in the minimal intervention strategy group and 9%in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of followup in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain). Conclusion: This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual care.
文摘Background: Recommendations for the management of low back pain in primary ca re emphasise the importance of recognising and addressing psychosocial factors a t an early stage. We compared the effectiveness of a brief pain- management pro gramme with physiotherapy incorporating manual therapy for the reduction of disa bility at 12 months in patients consulting primary care with subacute low back p ain. Methods: For this pragmatic, multicentre, randomised clinical trial, eligib le participants consulted primary care with non- specific low back pain of less than 12 weeks’ duration. They were randomly assigned either a programme of pa in management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Ana lysis was by intention to treat. Findings: Of 544 patients assessed for eligibil ity, 402 were recruited (mean age 40.6 years) and 329 (82% )- reached 12- mon th follow- up. Mean disability scores were 13.8 (SD 4.8) for the pain- managem ent group and 13.3 (4.9) for the manual- therapy group. The mean decreases in d isability scores were 8.8 (6.4) and 8.8 (6.1) at 12 months (difference 0 [95% CI - 1.3 to 1.4], p=0.99), and median numbers of physiotherapy visits per patie nt were three (IQR one to five) and four (two to five), respectively (p=0.001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded. Interpretation: Brief pain management techniques delivered by appropri ately trained clinicians offer an alternative to physiotherapy incorporating man ual therapy and could provide a more efficient first- line approach for managem ent of non- specific subacute low back pain in primary care.
