Vanderbilt University Medical Center was one of the largest enrolling centers in a cluster randomized clinical trial to determine whether multidisciplinary biopsychosocial intervention or individualized postural therapy (IPT) intervention improved disability and reduced health care spending in patients with acute or subacute spine pain.
Of 2,971 total patients from 33 centers, VUMC recruited 1,154 from primary care and walk-in clinics including Vanderbilt Health One Hundred Oaks, Belle Meade and Franklin. Collaborators include Harvard Medical School and Brigham Women’s Hospital and Stanford University School of Medicine.
Low back and neck pain are among the leading causes of medical visits, lost productivity and disability.
The four-year study involved recruitment of patients with neck and/or back pain for three months or less from June 2017 to March 2020, then followed all patients for one year, culminating in a paper published Dec. 20, 2022, in JAMA.
Patients who consented to be in the study were referred to one of the study arms based on the clinic: The three arms of the study included Identify, Coordinate, and Enhance (ICE) care model, IPT intervention and usual PCP-led care.
“ICE involved having patients complete a brief screening tool. Patients identified as low risk were referred for one physical therapy session and one spine care coach call that included motivational interviewing to help engage patients in their own care and promote self-efficacy,” says Kristin Archer, PhD, DPT, director of the Vanderbilt Center for Musculoskeletal Research and primary investigator responsible for overseeing all study procedures at 12 sites. “Patients identified as medium or high risk were referred for three PT sessions and three spine coach calls. A physiatrist reviewed the patient’s medical chart and made recommendations, if any, about additional therapeutic options. The IPT arm involved up to nine sessions of supervised exercise by a trained professional, either in person or via video call to improve spinal alignment and postural control.”
All patients completed questionnaires at three and 12 months after being enrolled in the study.
The study found that patients in the ICE and IPT arms had a greater reduction in disability at their three-month follow-up than patients in the usual care arm.
“Seventy percent of patients in ICE and 67% of patients in IPT had a clinically significant reduction in disability compared to 57% in the usual care arm at three months,” Archer says. “Patients in both of the interventions also had a greater reduction in disability and greater improvements in quality of life and self-efficacy at 12 months than patients in the usual care arm, Archer said.
Health care costs between the ICE and usual care arms, $1,448 and $1,587 respectively, were similar. Spending for patients in the IPT arm ($2,528) was significantly higher than usual care.
According to Archer, this study demonstrates that providing a targeted biopsychosocial rehabilitation approach to patients with acute or subacute spine pain can improve short- and long-term outcomes without increasing health care costs.
This paper is important information for physical and occupational therapists, and those who work in rehabilitation and primary care medicine.
“This study provides an opportunity for primary care providers to consider a different approach for treating patients with spine pain that includes a brief screening tool and a stratified management approach to rehabilitation referral,” Archer said. “Primary care providers may want to integrate a brief screening tool in their clinical workflow in order to improve clinical decision making since patients identified as low risk may need a different management plan than those identified as medium or high risk.”
