Chronic low back pain (LBP) is a leading cause of disability with a lifetime prevalence of 80-85%. It presents a management challenge due to complex, interdependent relationships between biomedical features and concomitant psychological and social factors. There is growing evidence to support using a biosychosocial model as part of the physiotherapy management of this patient cohort. The Subgroups for Targeted Treatment (STarT) Back randomised controlled trial and implementation study in Keele, UK have demonstrated the clinical and cost-effectiveness of stratified care for the management of LBP. Stratfication is based on prognostic risk stratification into low, medium and high risk groups with risk-matched treatment. Recently, in Ireland the HSE funded 30 physiotherapists to receive this risk-matched training. This pilot observational study aims to test the feasibility of undertaking a full scale study investigating the implementation of stratified care compared to usual physiotherapy care in the management of patients with low back pain in two Dublin based hospitals.
Eligible and consenting patients will complete the STarTback screening tool at baseline, along with other outcomes including back pain disability, psychosocial measures related to mood, catastrophising and beliefs about pain. Outcomes will be repeated on completion of treatment (stratified care compared with traditional physiotherapy) to determine the effect of using this stratified approach on clnical outcomes. We also aim to ascertain the feasibiltiy of undertaking a larger implementation study in an Irish context.