Authors (including presenting author) :
Tam CL(1), Ngan KTS(1), Chan TF(1), Chu WY(1), Fung YK(1)
Affiliation :
(1)Physiotherapy Department, Tseung Kwan O Hospital, Hospital Authority
Keyword 1: :
Stratified Care Model
Keyword 2: :
STarT Back Screening Tool
Keyword 3: :
Prognostic risk
Introduction :
Stratified Care Model (SCM), based on the STarT Back Screening Tool (SBST), facilitates physiotherapists in providing tailored care according to patients’ prognostic risk for better outcomes and resource utilization in Low Back Pain (LBP) management. A corresponding treatment pathway by SCM approach was implemented in the Physiotherapy Out-Patient Department (PT OPD) for all indicated patients since July 2025.
Objectives :
1.To compare the clinical outcomes of LBP patients managed under the SCM versus standard care.
2.To examine the efficacy in physiotherapy utilization between the two approaches, including number of sessions and treatment period.
Methodology :
This retrospective subgroup analysis included discharged LBP patients managed under either the SCM or standard care in PT OPD from July to Dec 2025. Patients in the SCM were risk‑stratified by SBST into low, medium and high-risk groups and received corresponding treatment pathways, while standard care group received non‑stratified care according to usual practice. Outcomes assessed at discharge included changes in the Numeric Pain Rating Scale (NPRS), Numerical Global Rating of Change Scale (NGRCS) and Roland‑Morris Disability Questionnaire (RMDQ), as well as the number of treatment sessions and period of treatment. Independent t-test was used to analyze the between-group differences.
Result & Outcome :
Result
Sixty-nine and 160 patients were discharged under the SCM and standard care respectively. Compared to standard care, the SCM group demonstrated significantly fewer treatment sessions (4.8 vs 6.2, p=0.016) and a significantly shorter physiotherapy treatment period (6.2 vs 9.0 weeks, p=0.002). No significant differences were observed in other outcomes (all p>0.05), including the changes in NPRS (−2.2 vs −2.8), NGRCS (+4.8 vs +4.9) and RMDQ (−2.9 vs −2.0). This indicated comparable improvements in pain, global perceived change and functional disability between two approaches. Within the SCM group, the average number of sessions increased with SBST risk level (low: 3.2, medium: 5.4, high: 7.3), demonstrating appropriate resource allocation aligned with the prognostic risk. Conclusion
The implementation of SCM for LBP demonstrated clinical improvements in pain, functional disability, and global perceived change comparable to standard care, but with significantly fewer treatment sessions and a shorter treatment duration. These findings support the feasibility of the SCM as a more efficient physiotherapy pathway for managing LBP patients without compromising overall outcomes.
