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Hill et al. Comparison of stratified primary care management for low-back pain with current best practice

One-paragraph summary

The trial randomized 851 English primary-care participants with low-back pain to prognosis-stratified matched care (568) or current best practice (283). Adjusted between-group RMDQ differences favored stratified care by 1.81 points (95% CI 1.06–2.57) at four months and 1.06 (0.25–1.86) at 12 months; the intervention added 0.039 QALYs and reduced mean back-pain healthcare costs (£240.01 vs £274.40) (PMID 21963002). It established a service-delivery model, not a DDD diagnostic or disc-specific treatment.

Key findings

  • 851 randomized participants from ten general practices.
  • 2:1 allocation to stratified versus control care.
  • Four-month RMDQ difference 1.81 (95% CI 1.06–2.57).
  • Twelve-month RMDQ difference 1.06 (0.25–1.86).
  • Additional 0.039 QALYs at 12 months.
  • Mean back-pain healthcare cost £240.01 versus £274.40.

Limitations

  • Conducted in one UK delivery system.
  • Participants and clinicians could not be blinded.
  • Population included back pain with or without radiculopathy, not DDD.
  • Later implementation trials did not uniformly replicate benefit.
  • Screening tool predicts prognosis, not pain source.

Why it matters

The trial showed that matching care intensity to prognostic risk could improve value. It also became a case study in why successful service models require replication in local systems.

Cited by wiki pages

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