Is stratified care more effective for sciatica than usual care?
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The term sciatica refers to pain that radiates from the low back to the posterior leg and is often associated with sensory and motor deficits. Sometimes the pain only affects the leg, sparing the low back. The pain is most commonly caused by a prolapsed lumbar disc compressing one of the lumbar spinal nerve roots.
Sciatica patients are often managed by primary care physicians using what can be termed ‘usual care’. This type of care involves a stepped-care approach that initially involves conservative interventions like advice, medications and physiotherapy (or chiropractic care). If patients do not improve within a reasonable time period, they are subsequently referred for imaging, assessment by a specialist and possibly more invasive treatments, like injections and surgery. This stepped approach is thought to be advantageous because patients with prolonged symptoms have been shown to experience worse outcomes. Nonetheless, there is currently a great deal of variation in clinical practice as to which patients need additional care and at what point referral should be made.
A stratified care approach has been developed for patients with non-specific low back pain, which has been shown to be both clinically and cost effective. The stratified care approach involves the use of a stratification tool that identifies patients’ risk of developing disability due to persistent back pain and then matches them to appropriate treatments. However, it is not known whether this approach would be effective for patients presenting with sciatica.
The objectives of this study were to investigate whether the stratified care model leads to faster resolution of sciatica symptoms as compared with non-stratified usual care, and whether this approach is cost-effective…LOG IN OR SUBSCRIBE TO ACCESS THIS REVIEW!
NEW THIS WEEK: “Stratified vs. Usual Care for Sciatica”
This paper was published in the Lancet Rheumatology (2020) and this Review is posted in Recent Reviews, Lumbar Spine - Disc & Neurological and the 2020 Archive.