Classification-based care for low back pain reduces sick leave days and the utilization of health services

In the "Trust Your Back" study, led by researcher Anna Sofia Simula from the University of Oulu, and her colleagues, the effectiveness of classification-based treatment for low back pain patients was evaluated concerning physical function, quality of life, sick leave days, and healthcare utilization compared to usual care. The study was conducted in three primary healthcare regions (South Savo, South Karelia, and Rovaniemi), involving a total of 654 low back pain patients.

Classification was performed using the STarT Back Screening Tool developed in the UK, which assigns low back pain patients to three different levels of care pathways based on their treatment needs. Healthcare units were designed to implement treatment pathways suitable for different risk categories.

All patients received a patient education booklet for low back pain management to support evidence-based care. The booklet was a key component in the management of low-risk patients, who were not systematically recommended follow-up visits or further rehabilitation in healthcare settings. Moderate-risk patients were additionally referred for follow-up visits with a physiotherapist. High-risk patients were offered an appointment with a physiotherapist within a week, focusing on potential psychosocial factors that might prolong recovery. Data were collected from participants at baseline and at three and 12 months.

Patients receiving classification-based treatment showed improvements in pain, functional ability, and quality of life already at the three-month follow-up, reaching a level that the conventional care comparison group achieved by the 12-month follow-up.

Over the course of one year, imaging studies of the lower back were performed for 16% of the study group and 26% of the control group patients. The average number of sick leave days during the year was 10 days in the study group and 18 days in the control group.

"Due to the likely positive cost effects, we recommend the implementation of a classification-based treatment model for low back pain patients in Finland and in the similar healthcare systems,” says Simula.

Low back pain is the most disabling health problem globally, resulting in significant costs to the healthcare system and society. In Finland, over 90 million euros were paid out in sickness allowances due to back disorders in 2022. In 2023, there were over half a million doctor visits in outpatient healthcare for back-related issues.

The results of the effectiveness study were published in the Journal of Rehabilitation Medicine: Simula, A. S., Malmivaara, A., Booth, N., & Karppinen, J. (2024). Effectiveness of a classification-based approach to low back pain in primary care – a benchmarking controlled trial: Trust your back. Journal of Rehabilitation Medicine, 56, jrm28321. https://doi.org/10.2340/jrm.v56.28321