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. 2024 May 9;24(1):611.
doi: 10.1186/s12913-024-11031-x.

Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months

Sara Ahmed  1   2   3   4   5 , Regina Visca  6   7   8 , Amede Gogovor  9   10 , Owis Eilayyan  11 , Roderick Finlayson  8 , Marie-France Valois  10 , Mark A Ware  6   8 ; McGill Réseau Universitaire Intégré de Santé et Services Sociaux (RUISSS) Center of Expertise in Chronic Pain Low Back Pain Network
Affiliations

Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months

Sara Ahmed et al. BMC Health Serv Res. .

Abstract

Background: Integrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program.

Methods: Patients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes.

Results: Four hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability.

Conclusion: The outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.

Keywords: Chronic pain; Integrated care; Low back pain; Person-centred care; Primary care; Sub-acute pain.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Treatment of non-specific subacute low back pain. McGill RUISSS Center of expertise clinical chronic pain program
Fig. 2
Fig. 2
McGill RUISSS. Center of expertise clinical process and trajectories to other services
Fig. 3
Fig. 3
Minimal Clinical Important Difference (MCID) for pain intensity and pain interference. MCID = 0.5 SD
Fig. 4
Fig. 4
Minimal Clinical Important Difference (MCID) for depression and anxiety. MCID = (Depression = 2.1, Anxiety = 1.9)
Fig. 5
Fig. 5
Minimal Clinical Important Difference (MCID) for self-efficacy
See this image and copyright information in PMC

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