Low Back Pain
Conditions
Keywords
low back pain, emergency, feasibility, implementation
Brief summary
The STarT Back Screening Tool (SBST) has been used in different healthcare settings in order to stratify the management of patients with low back pain. However, to date, no study has investigated the feasibility of implementing the SBST in emergency departments. The objective of this study will be to test the implementation of the SBST in the stratification of patients seeking care in emergency departments.
Detailed description
The Start Back Screening Tool (SBST) aims to identify and stratify primary care patients by using modifiable prognostic indicators that are relevant in clinical decision making. The objective of this study will be to test the feasibility of the implementation of the SBST in the stratification of patients seeking care in emergency departments. Study design: A prospective longitudinal cohort study with a 6-month follow-up. Intervention: At 6-weeks after baseline consultation, patients will be targeted to the specific treatment according to their subclassification in the SBST tool: education about pain neurophysiology and physical therapy. This is the first study that will provide results about logistic processes of the implementation of the SBST in the emergency sector, present feasibility data for the conduction of a large randomized controlled trial of subgroups of low back pain.
Interventions
OTHERSTarT Back Screening Tool Approach
Patients classified as low risk of persistent pain will be educated about their condition and how to manage their back pain by targeting modifiable prognostic factors. Patients classified as medium risk will receive evidence-based physical therapy. Patients classified as high risk will receive evidence-based physical therapy as well as individualized psychological intervention.
Sponsors
Universidade Cidade de Sao Paulo
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* We will include patients with back pain seeking care in emergency departments
Exclusion criteria
* We will exclude patients with serious spinal pathologies (such as cancer, fractures, inflammatory and infectious diseases) as well as pregnant patients and patients with nerve root compromise.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility from the perspective of the patient | Adoption at 6 weeks (i.e. at the implementation of treatment after stratification) | Feasibility will be measured by using 4 constructs (Adoption, adequacy, feasibility and fidelity). These constructs will be measured by using yes/no questions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity measured by a 0-10 Pain Numerical Rating Scale | 1, 2, 6 weeks and 3 and 6 months after first consultation at the emergency department. | Pain intensity will be measured by an 11-point (0-10) Pain Numerical Rating Scale (Pain NRS). Higher scores indicates higher pain intensity. |
| Disability measured by the 0-24 Roland Morris Disability Questionnaire | 6 weeks and 3 and 6 months after first consultation at the emergency department. | Disability will be measured by the 24-item Roland Morris Disability Questionnaire. Higher scores indicates higher disability. |
| Risk of persistent disability measured by the 0-9 Start Back Screening Tool. | 1, 2, 6 weeks and 3 and 6 months after first consultation at the emergency department. | Risk of persistent disability will be measured using the 0-9 point Start Back Screening Tool. The higher the score the higher is the risk of persistent disability. |
| Recovery from pain | 1, 2, 6 weeks and 3 and 6 months after first consultation at the emergency department. | Recovery from pain will be measured using a yes/no question (i.e. Were you completely free of back pain over the last month?) |
| Depressive symptoms over the last week. | 1, 2, 6 weeks and 3 and 6 months after first consultation at the emergency department. | Depression will be measured by a single question on how depressed patients were over the last week (measured on a 0-10 likert scale) |
| Recurrence of low back pain symptoms | 6 weeks and 3 and 6 months after first consultation at the emergency department. | Patients who recovered will be asked if they have experience a recurrence of symptoms |
| Global Impression of Recovery measured by the -5 to + 5 Global Perceived Effect Scale. | 1, 2, 6 weeks and 3 and 6 months after first consultation at the emergency department. | Global Impression of Recovery will be measured using the 11-item Global Perceived Effect Scale. Positive values represents recovery and negative values represents deterioration of symptoms. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Out of pocket costs associated with low back pain | 6 weeks and 3 and 6 months after first consultation at the emergency department. | Out of pocket costs will be measured using a 9-dimension cost diary |
Contacts
Primary ContactLuciola Costa, PhD
Outcome results
None listed