Authors (including presenting author) :
LAU NLK(1), CHEUNG PCT(1), SUEN MYAB(1), MAK MYM(2), LAW YTE(3)
Affiliation :
(1)Department of Physiotherapy, Tin Shui Wai Hospital, (2)Department of Physiotherapy, Tuen Mun Hospital, (3)Department of Physiotherapy, Pok Oi Hospital
Introduction :
Back pain is one of the largest patient groups in physiotherapy out-patient department. STarT-Back approach is a stratified care program aims at self-management of back pain. This study aims to evaluate its effectiveness by exploring the amount of patients require another course of back physiotherapy post-program.
Objectives :
1. To evaluate the outcome of stratified care program in management of non-specific back pain. 2. To explore the amount of program participant that required back physiotherapy again due to back pain.
Methodology :
Adult patients referred to Tuen Mun Hospital and Tin Shui Wai Hospital Physiotherapy Department with non-specific back pain at any duration, and accepted exercise training approach were included. Exclusion criteria included patients with potentially unstable medical or mental conditions, undergone spinal surgery in the past 6 months, pregnancy, injury-on-duty, road traffic accident or with ongoing litigation. Patients were stratified into 3 different treatment groups (i.e. low, medium and high risk) based on their score of STarT-Back questionnaire they completed in the first session. They would then receive different sessions of standardized physiotherapy class accordingly. Outcome measures were 1) Numerical Pain Rating Scale (NPRS), 2) Roland Morris Disability Questionnaire (RMDQ), 3) amount of patients require back physiotherapy again post-program.
Result & Outcome :
From 1 Jan to 30 Jun 2018, 320 patients have joined the program. All participants reported significant improvement in NPRS and RMDQ (both p<0.001). 23 patients (7.2%) attended physiotherapy again due to same condition within 6 months post-program (95%CI[0.044, 0.101]). NPRS and RMDQ improved significantly for both groups that required (p=0.017 and p=0.028 respectively) or not required (both p<0.001) back physiotherapy again. We found that there is a significantly higher default rate in the group that required physiotherapy again than the group that did not (Chi-square=3.834, p=0.050). Thus, we suggested that exercise compliance may be one of the reasons they required physiotherapy again. Strategies to improve exercise compliance are needed to be further explored in the future. Conclusion Stratified and standardized treatment approach is effective in managing non-specific low back pain. A small amount of patients require back physiotherapy again, which may due to exercise compliance problem.
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