Patients’ Views on the Implementation Potential of a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

Abstract

Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.

Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis

“…First, digital therapy apps provide a scalable and broadly accessible approach, enabling the treatment of LPB in rural areas and when the availability and workload of physiotherapists are limited [ 15 ]. Moreover, although stratified care is not yet implemented in routine care in Germany (eg, using the STarT-Back questionnaire), digital therapy apps enable early and immediate utilization for patients at high risk for developing a worsening or chronic condition [ 16 , 17 ]. Digital therapeutic care apps also support self-management and increase the patient’s literacy through in-depth educational information [ 18 ].…”

A cross-sectional hospital-based study of correlates of disability in patients with chronic low back pain in KwaZulu-Natal, South Africa

“…Gcelu et al also reported that, “medical schools have to introduce students to the diagnosis and treatment of MSKD disorders early, general physicians and other specialists need to have greater exposure to these conditions and primary care workers should be trained to manage these MSKD disorders” [ 13 ]. The risky effects of manual work which is related to physical injury (be it microtrauma) has been well documented and is where the biomedical model of management stems [ 20 ]. However, due to the multifactorial nature of CLBP, this model (biomedical) alone failed to explain the mosaic of the pathophysiology of CLBP disability [ 55 ].…”

“…However, due to the multifactorial nature of CLBP, this model (biomedical) alone failed to explain the mosaic of the pathophysiology of CLBP disability [ 55 ]. Thus, evidence has shown limited effectiveness of this traditional approach to management [ 20 ].…”

“…Given the multifactorial nature of CLBP and its predominant psychosocial predisposition, the traditional biomedical model of management has shown limited effectiveness, thus evidence suggests that interventions should focus on a patient centered holistic biopsychosocial approach [ 20 ]. Therefore, identification of these psychosocial predictors is an important initial step to effective management.…”

Risk-based stratified primary care for common musculoskeletal pain presentations: qualitative findings from the STarT MSK cluster randomised controlled trial

“…Qualitative research into the views of patients and clinicians on the use of risk-based strati ed care for LBP in Germany [30,31] found that patients were not convinced about the idea of being matched to treatments based on their risk of poor outcome and placed greater importance on receiving a diagnosis for their pain condition. Whilst GPs in the present study reported that patients presenting with MSK pain commonly had the expectation of being referred for imaging in order to identify the underlying cause of their pain, they were able to manage these expectations through using strati ed care to facilitate negotiation between the risk-matched treatment options and patients' preferences.…”