PDF(Pubmed)
Abstract：
OBJECTIVE: To explore if there are differences in the design and/or conduct of studies that have tested the STarTBack treatment approach for the management of low back pain (LBP), potentially explaining differences in study results.
METHODS: A literature review.
METHODS: MEDLINE, CINAHL and EMBASE were searched from inception to 26 July 2023.
METHODS: We included studies that included (1) participants with LBP and/or leg pain, (2) randomised controlled trials, controlled clinical trials and interrupted time series designs, (3) used the STarTBack Tool to stratify participants into subgroups and (4) studies provided matched treatments according to participants STarTBack score.
METHODS: Two review authors independently reviewed the search results and extracted data into the data extraction form. Due to the exploratory nature of this study, results are presented descriptively.
RESULTS: 11 studies conducted across 5 countries were included. There were substantial differences in the proportion of participants allocated to the different risk groups; low-risk group (range: 19%-58%), medium risk group (range: 31%-52%) and high-risk group (range: 6%-38%). There were large differences between studies in the implementation of the STarTBack approach. The original STarTBack trial (Hill et al, 2011) had a more explanatory design while in many subsequent studies, the design was more pragmatic/real world. Only the two original studies provided clear evidence that the implementation of the STarTBack tool led to a higher proportion of participants receiving matched treatment. In the other studies, there was no evidence of a difference, or it was unclear. In two studies, a researcher made the decision about which matched treatment participants received based on the STartTback Tool, while in nine studies, this was done by a clinician. Most studies recommended the same matched treatment for each risk group as per the original study except for a small number of studies. Only three studies reported whether the clinician delivering matched treatment followed the recommended treatment as per the tool. There was substantial variability in the training clinicians received.
CONCLUSIONS: Reporting of important study-level factors (eg, differences in study design, whether clinicians were trained and how the tool was used in each study) in how the STarTBack approach was implemented was unclear. There is some suggestion that key factors may include the individual who implemented the STarTBack tool, whether the recommendations of the tool were followed, the amount of training the clinician delivering the matched treatment received, and whether clinicians actually delivered the matched treatment.
METHODS: A literature review.
METHODS: MEDLINE, CINAHL and EMBASE were searched from inception to 26 July 2023.
METHODS: We included studies that included (1) participants with LBP and/or leg pain, (2) randomised controlled trials, controlled clinical trials and interrupted time series designs, (3) used the STarTBack Tool to stratify participants into subgroups and (4) studies provided matched treatments according to participants STarTBack score.
METHODS: Two review authors independently reviewed the search results and extracted data into the data extraction form. Due to the exploratory nature of this study, results are presented descriptively.
RESULTS: 11 studies conducted across 5 countries were included. There were substantial differences in the proportion of participants allocated to the different risk groups; low-risk group (range: 19%-58%), medium risk group (range: 31%-52%) and high-risk group (range: 6%-38%). There were large differences between studies in the implementation of the STarTBack approach. The original STarTBack trial (Hill et al, 2011) had a more explanatory design while in many subsequent studies, the design was more pragmatic/real world. Only the two original studies provided clear evidence that the implementation of the STarTBack tool led to a higher proportion of participants receiving matched treatment. In the other studies, there was no evidence of a difference, or it was unclear. In two studies, a researcher made the decision about which matched treatment participants received based on the STartTback Tool, while in nine studies, this was done by a clinician. Most studies recommended the same matched treatment for each risk group as per the original study except for a small number of studies. Only three studies reported whether the clinician delivering matched treatment followed the recommended treatment as per the tool. There was substantial variability in the training clinicians received.
CONCLUSIONS: Reporting of important study-level factors (eg, differences in study design, whether clinicians were trained and how the tool was used in each study) in how the STarTBack approach was implemented was unclear. There is some suggestion that key factors may include the individual who implemented the STarTBack tool, whether the recommendations of the tool were followed, the amount of training the clinician delivering the matched treatment received, and whether clinicians actually delivered the matched treatment.
摘要：
目的：为了探索在设计和/或实施的研究中是否存在差异，这些研究已经测试了用于治疗腰背痛（LBP）的STarTBack治疗方法，可能解释研究结果的差异。
方法：文献综述。
方法：MEDLINE，CINAHL和EMBASE从成立到2023年7月26日进行了搜索。
方法：我们纳入的研究包括（1）患有LBP和/或腿部疼痛的参与者，（2）随机对照试验，对照临床试验和中断的时间序列设计，（3）使用STarTBack工具将参与者分为亚组，（4）研究根据参与者STarTBack评分提供匹配的治疗。
方法：两位综述作者独立审查了搜索结果，并将数据提取到数据提取表中。由于这项研究的探索性，结果以描述性方式呈现。
结果：纳入了在5个国家进行的11项研究。分配给不同风险组的参与者比例存在实质性差异；低风险组（范围：19％-58％），中等风险组（范围：31%-52%）和高风险组（范围：6%-38%）。在实施STarTBack方法方面，研究之间存在很大差异。最初的STarTBack试验(Hill等人，2011)有一个更具解释性的设计，而在许多后续研究中，设计更加务实/现实世界。只有两项原始研究提供了明确的证据，表明STarTBack工具的实施导致接受匹配治疗的参与者比例更高。在其他研究中,没有差异的证据,或者不清楚。在两项研究中，研究人员根据STartTback工具决定接受哪些匹配的治疗参与者，在九项研究中，这是由临床医生完成的。除了少量研究外，大多数研究建议对每个风险组进行与原始研究相同的匹配治疗。只有三项研究报告了提供匹配治疗的临床医生是否按照该工具进行了推荐的治疗。临床医生接受的培训存在很大差异。
结论：报告重要的研究水平因素（例如，研究设计的差异，临床医生是否接受过培训以及该工具如何在每项研究中使用)如何实施STarTBack方法尚不清楚.有人建议，关键因素可能包括实施STarTBack工具的个人，是否遵循了工具的建议，临床医生提供所接受的匹配治疗的训练量，以及临床医生是否真的提供了匹配的治疗。
方法：文献综述。
方法：MEDLINE，CINAHL和EMBASE从成立到2023年7月26日进行了搜索。
方法：我们纳入的研究包括（1）患有LBP和/或腿部疼痛的参与者，（2）随机对照试验，对照临床试验和中断的时间序列设计，（3）使用STarTBack工具将参与者分为亚组，（4）研究根据参与者STarTBack评分提供匹配的治疗。
方法：两位综述作者独立审查了搜索结果，并将数据提取到数据提取表中。由于这项研究的探索性，结果以描述性方式呈现。
结果：纳入了在5个国家进行的11项研究。分配给不同风险组的参与者比例存在实质性差异；低风险组（范围：19％-58％），中等风险组（范围：31%-52%）和高风险组（范围：6%-38%）。在实施STarTBack方法方面，研究之间存在很大差异。最初的STarTBack试验(Hill等人，2011)有一个更具解释性的设计，而在许多后续研究中，设计更加务实/现实世界。只有两项原始研究提供了明确的证据，表明STarTBack工具的实施导致接受匹配治疗的参与者比例更高。在其他研究中,没有差异的证据,或者不清楚。在两项研究中，研究人员根据STartTback工具决定接受哪些匹配的治疗参与者，在九项研究中，这是由临床医生完成的。除了少量研究外，大多数研究建议对每个风险组进行与原始研究相同的匹配治疗。只有三项研究报告了提供匹配治疗的临床医生是否按照该工具进行了推荐的治疗。临床医生接受的培训存在很大差异。
结论：报告重要的研究水平因素（例如，研究设计的差异，临床医生是否接受过培训以及该工具如何在每项研究中使用)如何实施STarTBack方法尚不清楚.有人建议，关键因素可能包括实施STarTBack工具的个人，是否遵循了工具的建议，临床医生提供所接受的匹配治疗的训练量，以及临床医生是否真的提供了匹配的治疗。
