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首页> 外文期刊>Spine >Comparison of a Stratified Group Intervention (STarT Back) With Usual Group Care in Patients With Low Back Pain: A Nonrandomized Controlled Trial
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Comparison of a Stratified Group Intervention (STarT Back) With Usual Group Care in Patients With Low Back Pain: A Nonrandomized Controlled Trial

机译：下腰痛患者的分层小组干预（STarT背）与常规小组护理的比较：非随机对照试验

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Study Design.A nonrandomized controlled trial.Objective.This study aims to explore the effectiveness of group-based stratified care in primary care.Summary of Background Data.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.Methods.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.Results.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 4310.98 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).Conclusion.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.Level of Evidence: 2
机译：研究设计。一项非随机对照试验。目的。本研究旨在探讨基于团体的分层护理在初级护理中的有效性。背景数据摘要。基于心理社会筛查（STarT Back）的分层护理已显示出更大的临床和成本效益腰痛患者然而，腰痛干预通常是分小组进行的，因此在小组环境中评估该护理系统很重要。方法：从60例常规方法和相关的理疗服务中招募患者。将一个新的分层干预组与一个历史非分层对照组进行比较。为低，中和高风险分层的患者提供了风险匹配的团体护理。同意的参与者完成了关于功能障碍（主要结局指标），疼痛，心理困扰和信仰的自我报告。历史控制者接受了一般团体干预。结果：在第12周时，总共有251例新分层干预措施的患者和332例历史对照患者进入了初步分析。患者的平均年龄为4310.98岁。在12周的随访中，分层干预中RMDQ得分的总体调整后平均变化高于对照组（P = 0.028）。探索风险组（单独为高风险分层组）显示优于对照组的结果（P = 0.031）。中度危险分层干预表现出同样好的结果（P = 0.125），低危险分层患者尽管干预较少，但与历史对照一样表现良好（P = 0.993）。高风险患者的预后较好，中低风险组的预后也一样好。嵌入初级保健的该模型为慢性疾病管理提供了早期有效的模型，并为STarT Back保健系统的实用性增加了新的维度。证据级别：2

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