Authors (including presenting author) :
Chan SL(1), Leung YY(1), Yuen PM(1), Tse TK(1)
Affiliation :
(1) Department of Physiotherapy, Princess Margaret Hospital
Introduction :
Low back pain remains the top leading cause of years lived with disability globally, which imposes great demand on out-patient Physiotherapy Service. Multi-domain risk stratification model, the STarT-Back approach, which is designed to stratify patients into subgroups (high, medium and low risk) and provides risk-matched treatments accordingly, was adopted to address the issue. This is a preliminary service evaluation on the program.
Objectives :
To evaluate the outcomes of back stratified care program in terms of accessibility, efficiency and effectiveness.
Methodology :
This is a quasi-experimental study. Adults with low-back-pain conditions referred to Princess Margaret Hospital were included. Patients who were injury-on-duty, traumatic onset, post-operative, with concomitant conditions, or unstable mental status, non-Cantonese speaking and age above 70-year-old were excluded. Subjects first attended group-based back educational class and completed initial assessment. Patients were stratified into different risk groups by validated Keele STarT Back Screening Tool and received individual matched cares accordingly. Patient-specific outcomes, included Numeric global rating of change (NGRCS), Numeric Pain Rating Scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ), and service-based outcomes, including number of attendance and waiting time, were reported. Paired sample t-test was used to analyze within-group differences of NPRS and RMDQ.
Result & Outcome :
From April to September 2021, 478 patients were recruited with 2768 total attendances. All completed dataset was analyzed. 182 subjects (41% high risk, 27% medium risk and 32% low risk) with female-to-male ratio 2:1, average age of 55.6 (range: 18-70) were included. The mean waiting time was 2.1 weeks, which markedly reduced, compared to 2019 PMH waiting time for P2 “Back” cases (5.7 weeks) and R “Back” cases (28 weeks). Patients attended an average of 6.4 sessions, comparable to HA average. Average NGRCS (6.5) was higher than that of 19/20 HA average of 5.4. There is significant difference in pre- and post-NPRS scores with reduction of 3.5 (95% CI:3.066-3.644, p<0.001) and RMDQ with reduction of 4.3 (95%CI:3.643-4.784, p<0.001), which were higher than that of 19/20 HA average of 2.6 and 3.2 respectively. The stratified program demonstrated good cost-effectiveness by markedly reducing the waiting time and better outcomes with comparable numbers of sessions.
