Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial

Background: Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main t...

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Main Authors: Saunders, Benjamin, Hill, Jonathan C., Foster, Nadine E., Cooper, Vince, Protheroe, Joanne, Chudyk, Adrian, Chew-Graham, Carolyn, Bartlam, Bernadette
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2021
Subjects:
Online Access:https://hdl.handle.net/10356/146312
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Institution: Nanyang Technological University
Language: English
id sg-ntu-dr.10356-146312
record_format dspace
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Science::Medicine
Musculoskeletal Pain
Stratified Care
spellingShingle Science::Medicine
Musculoskeletal Pain
Stratified Care
Saunders, Benjamin
Hill, Jonathan C.
Foster, Nadine E.
Cooper, Vince
Protheroe, Joanne
Chudyk, Adrian
Chew-Graham, Carolyn
Bartlam, Bernadette
Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
description Background: Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main trial and of delivering prognostic stratified primary care for patients with musculoskeletal pain. The pilot RCT was conducted in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK development tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. This paper reports on a nested qualitative study exploring the feasibility of delivering stratified care ahead of the main trial. Methods: ‘Stimulated-recall’ interviews were conducted with patients and GPs in the stratified care arm (n = 10 patients; 10 GPs), prompted by consultation recordings. Data were analysed thematically and mapped onto the COM-B behaviour change model; exploring the Capability, Opportunity and Motivation GPs and patients had to engage with stratified care. Results: Patients reported positive views that stratified care enabled a more ‘structured’ consultation, and felt tool items were useful in making GPs aware of patients’ worries and concerns. However, the closed nature of the tool’s items was seen as a barrier to opening up discussion. GPs identified difficulties integrating the tool within consultations (Opportunity), but found this easier as it became more familiar. Whilst both groups felt the tool had added value, they identified ‘cumbersome’ items which made it more difficult to use (Capability). Most GPs reported that the matched treatment options aided their clinical decision-making (Motivation), but identified some options that were not available to them (e.g. pain management clinics), and other options that were not included in the matched treatments but which were felt appropriate for some patients (e.g. consider imaging). Conclusion: This nested qualitative study, using the COM-B model, identified amendments required for the main trial including changes to the Keele STarT MSK tool and matched treatment options, targeting the COM-B model constructs, and these have been implemented in the current main trial.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Saunders, Benjamin
Hill, Jonathan C.
Foster, Nadine E.
Cooper, Vince
Protheroe, Joanne
Chudyk, Adrian
Chew-Graham, Carolyn
Bartlam, Bernadette
format Article
author Saunders, Benjamin
Hill, Jonathan C.
Foster, Nadine E.
Cooper, Vince
Protheroe, Joanne
Chudyk, Adrian
Chew-Graham, Carolyn
Bartlam, Bernadette
author_sort Saunders, Benjamin
title Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
title_short Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
title_full Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
title_fullStr Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
title_full_unstemmed Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial
title_sort stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the start msk feasibility and pilot cluster randomized controlled trial
publishDate 2021
url https://hdl.handle.net/10356/146312
_version_ 1759856205379928064
spelling sg-ntu-dr.10356-1463122023-03-05T16:43:01Z Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial Saunders, Benjamin Hill, Jonathan C. Foster, Nadine E. Cooper, Vince Protheroe, Joanne Chudyk, Adrian Chew-Graham, Carolyn Bartlam, Bernadette Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Musculoskeletal Pain Stratified Care Background: Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main trial and of delivering prognostic stratified primary care for patients with musculoskeletal pain. The pilot RCT was conducted in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK development tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. This paper reports on a nested qualitative study exploring the feasibility of delivering stratified care ahead of the main trial. Methods: ‘Stimulated-recall’ interviews were conducted with patients and GPs in the stratified care arm (n = 10 patients; 10 GPs), prompted by consultation recordings. Data were analysed thematically and mapped onto the COM-B behaviour change model; exploring the Capability, Opportunity and Motivation GPs and patients had to engage with stratified care. Results: Patients reported positive views that stratified care enabled a more ‘structured’ consultation, and felt tool items were useful in making GPs aware of patients’ worries and concerns. However, the closed nature of the tool’s items was seen as a barrier to opening up discussion. GPs identified difficulties integrating the tool within consultations (Opportunity), but found this easier as it became more familiar. Whilst both groups felt the tool had added value, they identified ‘cumbersome’ items which made it more difficult to use (Capability). Most GPs reported that the matched treatment options aided their clinical decision-making (Motivation), but identified some options that were not available to them (e.g. pain management clinics), and other options that were not included in the matched treatments but which were felt appropriate for some patients (e.g. consider imaging). Conclusion: This nested qualitative study, using the COM-B model, identified amendments required for the main trial including changes to the Keele STarT MSK tool and matched treatment options, targeting the COM-B model constructs, and these have been implemented in the current main trial. Published version 2021-02-08T09:26:31Z 2021-02-08T09:26:31Z 2020 Journal Article Saunders, B., Hill, J. C., Foster, N. E., Cooper, V., Protheroe, J., Chudyk, A., . . . Bartlam, B. (2020). Stratified primary care versus non-stratified care for musculoskeletal pain : qualitative findings from the STarT MSK feasibility and pilot cluster randomized controlled trial. BMC Family Practice, 21(1), 31-. doi:10.1186/s12875-020-1098-1 1471-2296 0000-0002-0856-1596 https://hdl.handle.net/10356/146312 10.1186/s12875-020-1098-1 32046656 2-s2.0-85079339639 1 21 en BMC Family Practice © 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. application/pdf