Authors (including presenting author) :
Kam SWL(1), Yeung KCA(1),Lau SYJ(1), Siu HKE(1)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital
Introduction :
The STarT Back Screening tool (STarT Back), developed in the United Kingdom, is a tool for stratifying psychosocial risk factors in patients with low back pain (LBP) into low (LR) , medium (MR) and high (HR) level. Treatment package is matched and targeted accordingly. Studies have shown a better reduction of disability and more cost-effective outcomes. Roland Morris Disability Questionnaire (RMDQ) is a measure for disability in LBP. Patient could be classified as mild, moderate and high disability in a previous local study. By combining STarT Back and RMDQ (psychosocial and disability), a new local stratified care model for LBP management was developed in a local physiotherapy out-patient department (PTOPD) and implemented in the Annual Plan project 2019/2020 to address the increasing demand of physiotherapy outpatient service. It is expected that with this effective model of care, resources could be saved for tackling the waiting time. This study reported the preliminary results.
Objectives :
To observe the LBP patient profile in the new complexity categories of combining disability and psychosocial risks. To observe the clinical outcomes under the new stratified care model.
Methodology :
All patients diagnosed with LBP and referred to a PTOPD from 1 October, 2019 to 13 January, 2020 were reviews in this new stratified care. They completed both STarT Back and RMDQ. STarT Back was used as the first layer of categorization. LR group with low disability were given information, education and exercise for two sessions. MR or moderate disability were given evidence-based PT for 6-8 sessions. HR or high disability received psychologically informed physiotherapy (PIP) in addition to usual PT. PIP included exploration of psychosocial barriers for recovery, through motivational strategies to orientate patient toward one’s goal and meaningful living rather than pain control. The efficiency was reviewed by number of session received. The effectiveness was reviewed using Numerical Global Rate of Change Scale (NGRCS), Numerical Pain Rating Scale (NPRC) and RMDQ. Paired t-test was used for statistical analysis.
Result & Outcome :
In total, 357 cases were reviewed, with 254(71.1%) female and average 60 years old. In terms of STarT Back, there was 29.7% LR, 33.1% MR and 37.3% HR. In terms of complexity by combining STarT Back and RMDQ score, there was 22.1% of patients categorized to low complexity, 34.2% medium complexity and 43.7% high complexity. Up to 13 Jan, 2020, 123(34.5%) patients were discharged. Average attendance for low complexity was 1.7±2.7 (n=39), medium complexity 2.8±2 (n=35) and high complexity 4.0±2.7 (n=49). 73% of low complexity patient was discharged after 1 session of treatment. The average NGRCS was 6.0±2.9; NPRS decreased from 5.3 to 3.2 (p< 0.00) and RMDQ decreased from 11.4 to 8.3 (p< 0.00).In this preliminary observation, the number of sessions required fitting well to the service model and potentially require lesser session as planned. Moreover, LBP patients in Hong Kong Physiotherapy OPD public setting showed higher disability than psychosocial risk and this is an important factor for consideration in developing a local service model. Longer period of observation is required for reliable clinical outcomes.
