Table 4.
Process of Care and Clinical Outcomes at 6-Month Follow-up by Risk Group
| Low Risk | Medium Risk | High Risk | |||||||
|---|---|---|---|---|---|---|---|---|---|
|
|
|||||||||
| Outcome | Phase 1 (n = 136) |
Phase 3 (n = 214) |
P Valuea |
Phase 1 (n = 151) |
Phase 3 (n = 232) |
P Valuea |
Phase 1 (n = 81) |
Phase 3 (n = 108) |
P Valuea |
| Process of care outcomes | |||||||||
| Reconsulted physician, No. (%) | 19 (18) | 33 (22) | .43 | 39 (31) | 74 (41) | .056 | 30 (42) | 52 (58) | .03 |
| Prescribed medications, No. (%) | |||||||||
| Nonsteroidal anti-inflammatory drugs | 46 (43) | 43 (28) | .01 | 61 (48) | 71 (39) | .15 | 29 (40) | 45 (51) | .19 |
| Antidepressants | 2 (2) | 8 (5) | .16 | 19 (15) | 18 (10) | .20 | 10 (14) | 16 (18) | .48 |
| Nonopioids | 11 (10) | 11 (7) | .39 | 30 (23) | 30 (17) | .14 | 25 (35) | 12 (13) | .001 |
| Opioids | 19 (18) | 47 (31) | .02 | 44 (34) | 95 (53) | .001 | 25 (35) | 59 (66) | <.001 |
| Strong opioids | 12 (11) | 25 (16) | .24 | 37 (29) | 49 (27) | .75 | 24 (33) | 40 (45) | .13 |
| Weak opioids | 7 (7) | 22 (14) | .046 | 7 (5) | 46 (26) | <.001 | 1 (1) | 19 (21) | <.001 |
| Neuromodulators/antiepileptics | 0 (0) | 1 (1) | 1.00 | 10 (8) | 4 (2) | .02 | 8 (11) | 15 (17) | .30 |
| Issued sickness certification, No. (%) | 10 (9) | 11 (7) | .54 | 21 (16) | 16 (9) | .046 | 14 (20) | 13 (15) | .41 |
| Blood test ordered, No. (%) | 33 (31) | 50 (33) | .73 | 46 (36) | 65 (36) | .98 | 31 (43) | 39 (44) | .92 |
| MRI scan/radiograph ordered, No. (%) | 12 (11) | 10 (7) | .19 | 20 (16) | 29 (16) | .91 | 15 (21) | 16 (18) | .65 |
| Clinical outcomes | |||||||||
| Disability: change in RMDQ score | 0.9 (5.8) | 0.9 (4.5) | .87 | 3.4 (6.3) | 3.5 (6.0) | .21 | 2.3 (5.8) | 4.8 (6.8) | .004 |
| Achieved MCID,b No. (%) | 67 (49) | 103 (48) | .68 | 66 (44) | 113 (49) | .17 | 22 (27) | 45 (42) | .06 |
| Pain intensity: change in NRS rating | 1.0 (2.9) | 0.8 (3.0) | .83 | 2.3 (3.0) | 2.4 (3.1) | .52 | 1.9 (2.6) | 2.9 (3.3) | .02 |
| Physical function: change in SF-12 PCS score | −2.2 (15.2) | −2.6 (16.5) | .98 | −5.7 (13.9) | −4.0 (11.9) | .79 | −2.3 (13.1) | −6.1 (14.8) | .051 |
| Catastophizing: change in PCS-CAT score | 0.5 (7.8) | 0.5 (6.4) | .86 | 1.2 (7.3) | 1.1 (10.0) | .83 | 4.9 (8.6) | 6.0 (11.7) | .36 |
| Fear avoidance: change in TSK score | 2.8 (9.2) | 3.1 (8.4) | .42 | 1.7 (7.6) | 3.3 (7.5) | .02 | 3.3 (7.1) | 5.3 (12.3) | .09 |
| Anxiety: change in HADS subscale score | 0.7 (4.1) | 0.6 (4.2) | .82 | 0.8 (3.7) | 1.0 (4.0) | .09 | 2.1 (5.5) | 2.7 (4.3) | .22 |
| Depression: change in HADS subscale score | 0.4 (4.1) | 0.6 (3.8) | .90 | 1.4 (3.3) | 1.4 (3.3) | .45 | 1.2 (4.3) | 2.7 (3.6) | .007 |
| Mental health: change in SF-12 MCS score | −1.1 (13.4) | −0.2 (14.4) | .61 | −1.2 (13.8) | −2.0 (12.8) | .23 | −4.8 (17.4) | −6.4 (11.7) | .63 |
| Pain self-efficacy: change in PSEQ score | −4.9 (13.7) | −3.1 (13.4) | .31 | −9.6 (16.8) | −8.4 (15.2) | .72 | −8.4 (12.5) | −12.6 (17.0) | .07 |
| Global change since baseline: much improved, No. (%) | 67 (49) | 116 (54) | .48 | 53 (35) | 88 (38) | .11 | 19 (24) | 41 (38) | .09 |
| Risk group: low risk, No. (%) | 117 (86) | 197 (92) | .50 | 97 (64) | 169 (73) | .30 | 35 (43) | 57 (53) | .02 |
| Absenteeism since baselinec | 0.5 (2.3) | 0.9 (3.4) | .50 | 11.3 (26.3) | 5.3 (18.7) | .005 | 15.5 (35.5) | 9.4 (16.8) | .41 |
| Presenteeismc | 1.5 (2.0) | 1.2 (1.5) | .32 | 2.3 (2.3) | 2.3 (2.8) | .87 | 3.7 (3.1) | 3.2 (2.8) | .62 |
| Satisfied with care receivedd | 59 (75) | 81 (76) | .87 | 77 (75) | 99 (70) | .39 | 25 (54) | 35 (59) | .61 |
| Satisfied with results of cared | 48 (62) | 81 (76) | .03 | 63 (64) | 93 (68) | .50 | 22 (47) | 35 (61) | .14 |
Notes: Values are mean (SD) unless otherwise noted. See Table 3 for abbreviations.
P values were derived by χ2 test for the process outcomes, and by regression analyses for the clinical outcomes (adjusted for age, sex, family physician practice, baseline RMDQ score, duration of pain, and corresponding baseline value—as detailed in Table 3).
Based on an MCID (≥30% reduction in RMDQ score from baseline) and rating of “completely recovered” or “much better” or “better” according to the global change question.
Based on 290 of 547 respondents who reported being currently employed at the 6-month follow-up.
Based on 536 respondents for the care received question and 524 for the results of care question at the 6-month follow-up.