Does risk stratification with a matched treatment pathway improve clinical outcomes for adults with acute back pain? A systematic review and meta-analysis

Abstract

Background: Risk stratification is an approach which has been recommended across a number of international guidelines for the management of back pain.

Objective: To assess whether the use of risk stratification with a matched treatment pathway improves clinical outcomes, when compared with usual care or other interventions, in adults with acute back pain.

Methods: A comprehensive search was conducted of the databases Medline, Embase, PEDro, CINAHL and Cochrane Library in November 2022. Studies of adults with back pain of less than 3 months' duration and who had been stratified according to their level of risk of a poor functional outcome and provided with a treatment matched to their level of risk were included. Participants with specific and/or serious spinal pathologies were excluded.

Results: Five trials involving 3519 participants were included. Meta-analysis found very-low certainty evidence that the use of a risk stratification approach with matched treatment may lead to a very small reduction in pain levels at 3-6 months compared with usual care (MD -0.62, 95 % CI -0.88, -0.36). These results did not achieve clinical significance. No difference was found for the use of risk stratification compared to usual care for disability (MD -1.52, 95 % CI -4.15, 1.11).

Conclusion: The use of risk stratification with matched treatment may be just as worthwhile as usual care for acute back pain, however the evidence is very uncertain. Further high quality research is required to confirm whether risk stratification is a useful approach for this population.

Systematic review registration number: CRD42022379987.

Keywords: Adult; Back pain; Chronic pain; Disabled persons; Humans; Randomized controlled trials as topic.