Can primary care for back and/or neck pain in the Netherlands benefit from stratification for risk groups according to the STarT Back Tool-classification?

OBJECTIVE: To evaluate whether current Dutch primary-care clinicians offer tailored treatment to patients with lower-back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT). DESIGN: Prospective cohort study with 3 month follow-up SETTING: Primary care PARTICIPANTS: General practitioners (GPs) and physiotherapists (PTs) included patients with non-specific LBP and/or NP. INTERVENTIONS: Patients completed a baseline questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up measurement was conducted after 3 months to determine recovery (using the Global Perceived Effect (GPE) scale), pain (using the Numeric Pain-Rating Scale (NPRS)) and function (using the Roland Disability Questionnaire (RDQ) or the Neck Disability Index (NDI)). A questionnaire was sent to the GPs and PTs to evaluate the provided treatment. MAIN OUTCOME MEASURES: Prevalence of patients' risk profile and clinicians' applied care, and the percentage of patients with persisting disability at follow-up. A distinction was made between patients receiving the advised treatment and those receiving the non-advised treatment. RESULTS: In total, 12 GPs and 33 PTs included patients. After 3 months, we analyzed 184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low risk for persisting disability, 38.0% were at medium risk and 9.8% were at high risk. Overall, 24.5% of the LBP patients received a low-risk treatment approach, 73.5% a medium-risk and 2.0% a high-risk treatment approach. The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients (respectively 21.1% and 10.0%), and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients were at low risk for persisting disability, 37.0% were at medium risk and 5.0% were at high-risk. Only 6.1% of the patients with NP received the low-risk treatment approach. The medium-risk treatment approach was offered the most (90.8%) and the high-risk approach was applied in only 3.1% of the patients. The specific agreement between the risk profile and received treatment for NP patients was poor for low-risk and medium-risk patients (resp. 6.3% and 48.0%); agreement for high-risk patients could not be calculated. CONCLUSION: Current Dutch primary care for patients with non-specific LBP and/or NP does not correspond to the advised stratified-care approach based on the SBT as the majority of patients receive medium risk treatment. The majority of "low-risk" patients are over-treated and the majority of "high-risk" patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate that there may be substantial room for improvement

KNGF-richtlijn Nekpijn

De richtlijn is samengevat op een kaart. Alle onderdelen van de richtlijn zijn beschikbaar via www.kngfrichtlijnen.nl. © 2016 Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF) Alle rechten voorbehouden. Niets uit deze uitgave mag worden verveelvoudigd, opgeslagen in een geautomatiseerd gegevensbestand, of openbaar gemaakt, in enige vorm of op enige wijze, hetzij elektronisch, mechanisch, door fotokopieën, opnamen, of enig andere manier, zonder voorafgaande schriftelijke toestemming van het KNGF. Het KNGF heeft als doel om de voorwaarden te scheppen waardoor fysiotherapeutische zorg van goede kwaliteit gerealiseerd wordt, die toegankelijk is voor de gehele Nederlandse bevolking, met erkenning van de professionele deskundigheid van de fysiotherapeut. Het KNGF behartigt voor ruim 20.000 aangesloten fysiotherapeuten de belangen op beroepsinhoudelijk, sociaal-maatschappelijk en economisch gebied

Describing Treatment Effects to Patients: How They Are Expressed Makes a Difference

OBJECTIVE: To examine the impact of different presentations of equivalent information (framing) on treatment decisions faced by patients. DESIGN: A systematic review of the published literature was conducted. English language publications allocating participants to different frames were retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion, and assessed methodological quality. Study characteristics were tabulated and where possible, relative risks (RR; 95% confidence intervals) were calculated to estimate intervention effects. MEASUREMENTS AND MAIN RESULTS: Thirty-seven articles, yielding 40 experimental studies, were included. Studies examined treatment (N = 24), immunization (N = 5), or health behavior scenarios (N = 11). Overall, active treatments were preferred when outcomes were described in terms of relative rather than absolute risk reductions or number needed to treat. Surgery was preferred to other treatments when treatment efficacy was presented in a positive frame (survival) rather than a negative frame (mortality) (relative risk [RR] = 1.51, 95% confidence interval [CI], 1.39 to 1.64). Framing effects were less obvious for immunization and health behavior scenarios. Those with little interest in the behavior at baseline were influenced by framing, particularly when information was presented as gains. In studies judged to be of good methodological quality and/or examining actual decisions, the framing effect, although still evident, was less convincing compared to the results of all included studies. CONCLUSIONS: Framing effects varied with the type of scenario, responder characteristics, scenario manipulations, and study quality. When describing treatment effects to patients, expressing the information in more than one way may present a balanced view to patients and enable them to make informed decisions