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. 2021 Mar 4;4(1):e251.
doi: 10.1002/hsr2.251. eCollection 2021 Mar.

Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services: Protocol of a cluster randomized trial

Jaro Karppinen  1   2 , Anna Sofia Simula  1   3 , Riikka Holopainen  4 , Mikko Lausmaa  1 , Jouko Remes  2 , Maija Paukkunen  1   5 , Kasper Ussing  6   7 , Neill Booth  8 , Katja Ryynänen  1   9 , Tomi Koski  1   10 , Allan Abbott  5 , Birgitta Öberg  5 , Steven J Linton  11 , Anne Smith  12 , Peter O'Sullivan  12   13 , Antti Malmivaara  14
Affiliations

Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services: Protocol of a cluster randomized trial

Jaro Karppinen et al. Health Sci Rep. .

Abstract

Background: To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care.

Methods: The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18-65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant-level data) and the participating units' registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model.

Discussion: The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.

Keywords: STarT Back tool; biopsychosocial approach; cluster randomized controlled study; implementation research; low back pain; occupational health services; risk stratification; Örebro musculoskeletal pain screening questionnaire.

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Conflict of interest statement

Anna Sofia Simula, Riikka Holopainen, Maija Paukkunen, Kasper Ussing, Mikko Lausmaa, Peter O'Sullivan, Katja Ryynänen, and Jaro Karppinen have received payments for talks or clinical workshops related to a biopsychosocial approach for LBP care from organizations or clinics outside of the current study. Neill Booth, Jouko Remes, Allan Abbott, Birgitta Öberg, Tomi Koski, Anne Smith, Steven J. Linton, and Antti Malmivaara have no competing interests.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study. OHS, occupational health services; LBP, low back pain; SBT, STarT Back Tool; ÖMPSQ‐short, short version of the Örebro Musculoskeletal Pain Screening Questionnaire
FIGURE 2
FIGURE 2
Infographic of evaluation and treatment process of low back pain patients. LBP, low back pain; OH, occupational health; OHS, occupational health services; PT, physiotherapist
See this image and copyright information in PMC

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