Authors (including presenting author) :
Choi YK(1), Wong WL(3), Cheuk C(1), Lee MK(1), Yeung KC(3), Siu HK(3), Hui MT(1), Law SW(2), Leung KW(1)
Affiliation :
(1)Department of Family Medicine, the New Territories East Cluster, Hospital Authority, Hong Kong, (2)Department of Orthopaedics and Traumatology, Tai Po Hospital, New Territory, Hong Kong, (3)Department of Physiotherapy, Prince of Wales Hospital, New Territory, Hong Kong
Introduction :
Stratified care approach aims to allocate patients to different treatment pathway based on prognostic screening. It has demonstrated both clinical and cost effectiveness in managing patients with low back pain (LBP). STarT Back tool (SBT) is a validated questionnaire. It is designed to stratify LBP patients into groups of low, medium and high risk of persistent back disability. It has been used as a screening tool for stratified LBP healthcare model and it also guides clinicians in providing risk-matched treatments. Our study aims to evaluate the relationship of STarT Back risk groups with patients outcomes in family medicine (FM) clinic which might inform the future development of primary care LBP management model in our locality.
Objectives :
To assess the relationship of STarT Back risk groups with health service outcomes and patient-specific outcomes of LBP patients in the Prince of Wales hospital Family Medicine-Orthopaedics triage (FM-ORT) clinic.
Methodology :
LBP patients referred to orthopaedics department had initial assessment by physiotherapists and were invited to complete the SBT. Those who likely had no surgical needs were triaged to FM-ORT clinic. All LBP cases seen by FM physicians in 2018 were retrospectively reviewed till 31st Dec 2020. Their SBT scores were used to correlate with health service outcomes such as number of FM-ORT clinic visits and physiotherapy sessions, and patient-specific outcomes such as the pre and post physiotherapy Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ) and post physiotherapy Numerical Global Rate of Change (NGRC).
Result & Outcome :
229 out of 328 LBP cases had SBT done. There were 60 (26.2%) in low-risk, 73 (31.9%) in medium-risk and 96 (41.9%) in high-risk group. The discharge and default rate were 83% and 13.1%. The mean number of visits was 2.27±1.15. 27(45%) low-risk, 47(64.3%) medium-risk and 50(52.1%) high-risk patients received physiotherapy. High-risk group had more number of FM-ORT clinic visits than low-risk group after adjusted for age , sex and number of physiotherapy sessions (P=.037). High-risk group was associated with higher pre NPRS (P=.01) and pre RMDQ (P=.022). There were no correlation of STarT Back groups with number of physiotherapy sessions, changes of NPRS/ RMDQ and NGRC. The utility of SBT as prognostic indicator for LBP management needs further exploration.
