Is there agreement between usual care bye the general practitioner and the treatment recommendation of the STarT-Back-Tool on risk profile in patients with low back and neck pain?
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Objective: To investigate if there is an agreement between usual general practitioner (GP) care and the treatment recommendation of Start Back Tool + target treatment (SBT) by risk profile for patients with low back (LBP) and neck pain (NP). Design: A prospective Multi-Centre cohort study design Subjects: 50 patients with LBP and 50 patients with NP. Methods: To search for an agreement between usual GP care and the treatment recommendation of SBT we had: 1) Provided an questionnaire to GPs to determine which treatment method was applicable to which participants 2) Coded the content of the GP treatment 3) Divided the treatment method of the GP in low, medium and high treatment risk-profile subgroups 4) A check-up of which participant was treated on basis of which treatment risk-profile subgroup 5) Compared manually treatment risk-profile subgroup of each participant with his/her treatment risk-profile subgroup from SBT 6) Divided the patients in group A (treated according SBT ) if these risk-profiles matched and in group B (not treated according SBT) if not matched. Quantitative descriptive statistics are used to present a percentage of participation per group. After 12 weeks, the difference of function, pain and recovery rate between group A and B was calculated and also the prevalence of patients with a low, average or high risk of chronic complaints. Due to insufficient participants, the data was not being tested but just described. Results: For participants with LBP who have filled in the SBT at baseline, 54 % (n = 41) belong to the low-risk profile, 38 % (n = 29) belong to the medium-risk profile and 8 % (n = 6) belong to the high-risk profile. These values of neck pain are 52 % (n = 12), 39 % (n = 9) and 9 % (n = 2) respectively. 48 % of the participants were treated according to the SBT (Group A) and 52 % not (Group B). In Group A, the percentage in the subgroup No Restriction of Function (RDMQ/NDI) increased after treatment, and the percentage in subgroup Complete Restriction reduced. These changes occurred in Group B but to a lesser degree. Furthermore, there was a greater reduction in pain (NPRS) in Group A than Group B. 18% of participants in group A reported recovery (GPE) at the end of the follow-up versus 10% of group B. Conclusion: Paying attention to the data and the comparison that we have made between group A and B, we can suggest that the treatment according to the SBT leads to better results. Though there were fewer participants, the data was not analyzed and no harder conclusion could have been made. LBP and NP is a growing problem. The current high treatment costs and incorrect treatment in some cases, coupled with the cheaper and more responsible SBT treatments, mean that further study in this area is desirable.