Implementing the start back model of stratifying care for patients with low back pain seeking care in an emergency department: a prospective longitudinal cohort study

Abstract

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 SBST has been implemented in primary care in order to stratify the management of patients with acute back pain. Few studies have investigated the usefulness of this tool in other levels of care, such as in emergency departments. A recent study from our research group has identified that the best time to use the SBST for the treatment stratification to be received in the emergency sector would be 6 weeks after the first visit. However, to date, no study has investigated the plausibility of implementing this tool in emergency departments. Objectives: The objective of this study will be to test the implementation of the SBST in the stratification of patients seeking care in emergency departments. Methods: A prospective longitudinal cohort study with a 6-month follow-up will be conducted. Patients classified with a new episode of non-specific acute low back pain seeking emergency care will be evaluated during the first visit and will be followed up at 1 and 6 weeks, 3 and 6 months after first consultation evaluation. At 6-weeks, patients will be targeted to the specific treatment according to their subclassification in the SBST tool. Outcomes of interest will be: 1) feasibility from the perspective of the patient; 2) return to the health system for reassessment; 3) adherence to targeted treatment; 4) improvement in pain intensity, disability and return to work outcomes assessed 3 and 6 months after the initial evaluation and; 5) to investigate the feasibility of conducting a future randomized controlled trial with a larger sample. Finally, data will be collected regarding expenditures with the implementation of this treatment approach. Expected results: It is expected that at the end of this study we will gain a better understanding of the 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 and evaluate the costs related to the implementation process. (AU)