Thu0362 the Impact of a Referral Algorithm for Axial Spondyloarthritis: A Four Month Follow-Up of Patient Reported Outcomes

Abstract

BackgroundA substantial amount of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs).1 As a result, several referral strategies have been developed to help physicians identify patients at risk for axSpA within the large group of CLBP patients.2 Most referral strategies were developed in secondary care patients. The only referral strategy that was developed and validated in primary low back patients is the CaFaSpA strategy.3 An essential step before implementing referral strategies in daily clinical practice is the execution of an impact analysis.4 ObjectivesThe purpose of this study is to assess the impact of using a referral strategy on patient outcomes in young primary care patients with CLBP at risk for axSPA.MethodsA clustered randomized controlled trial was performed in a primary care setting (ClinicalTrials.gov Identifier: NCT01944163). Each cluster contained the general practices from a single primary care practice and their included patients. Clusters were randomized to either the intervention (use of CaFaSpA referral strategy) or the control group (usual care). Primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and 4 months. Secondary outcome was axSpA diagnosis made by a rheumatologist. A linear mixed-effects model was used to analyze mean change in RMDQ score.ResultsIn total 679 patients were included within 93 GP clusters. Sixty-four percent of our study population were female and mean age was 36 years. Median RMDQ score at baseline was 8 (IQR 4-12) in both groups. Compared to baseline, mean RMDQ score decreased by 0.74 points at 4 months (intervention) and by 0.46 points (control) (Fig. 1). This decrease did not significantly differ between groups (p=0.50). Eight percent of the finally referred patients in the intervention group, received an axSPA diagnosis (8%) from the rheumatologist. The median RMDQ among patients who visited the rheumatologist decreased from 8 to 5 after 4 month. This was not statistically significant (p-value=0.17).ConclusionAlthough the CaFaSpA referral strategy did not have an early impact on disability caused by CLBP, it can be used as a screening strategy for GPs to identify axSpA patients.References[1] Jois RN, Macgregor AJ, Gaffney K. Recognition of inflammatory back pain and ankylosing spondylitis in PC. Rheumatology (Oxford) 2008;47:1364-1366.[2] Abawi O, van den Berg R, van der Heijde D, van Gaalen FA. Evaluation of multiple referral strategies for axial spondyloarthritis in the SPondyloArthritis Caught Early (SPACE) cohort. RMD Open 2017 Apr 7;3(1):e000389-2016-000389. eCollection 2017.[3] van Hoeven L, Vergouwe Y, de Buck PD, Luime JJ, Hazes JM, Weel AE. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain. PLoS One 2015 Jul 22;10(7):e0131963.[4] Moons KG. Kengne AP, Grobbee DE, Risk prediction models: II. External valid...