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Background Non-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care. Methods A prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months' follow-up. In addition, information regarding the GP' practice was collected. Poor outcomes were determined according to the cutoff point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at � 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR). Results 110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (±SD) was 48.06 ± 11.41, with 53.9%, (N = 62)

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BackgroundThe results of a recent study have suggested that the current clinical practice is not in line with clinical guideline recommendations and may not be delivering the best outcomes to Low Back Pain (LBP) Portuguese patients. Since the stratified primary care approach has demonstrated clinical and cost-effectiveness in the UK and other countries, the SPLIT project aimed to introduce a similar approach that involves general practitioners (GPs) and physiotherapists (PTs) in the triage and targeted treatment for LBP patients, in Portugal. In order to facilitate the implementation of this project a training program for GPs and PTs was delivered by rheumatologists and PTs. Considering the specific organization of the Portuguese primary care, it was important to explore the perceptions of the GPs and PTs, who attended to the training, regarding the implementation of the SPLIT stratified model of care in the Portuguese context.ObjectivesIdentify and understand the potential barriers and facilitators to the implementation of the SPLIT stratified model of care.MethodsAfter obtaining ethical approval, two focus groups (one for each professional group) were carried out. The focus groups were based on a semi-structured interview schedule, audio-recorded and transcribed verbatim. A thematic analysis was conducted. Firstly, two researchers independently coded the transcripts. Secondly, these researchers discussed the codes and examined their scope and relevance. Thirdly, the researchers developed a coding scheme that included the main themes and sub-themes, as well as the connections among them.ResultsThe potential barriers were identified and explored by both professional groups. The introduction of change into the routine delivery care was identified as one of the most important barriers. According to the GPs` perspective, the possibility of inadequate referral was considered as an issue. The PTs highlighted the challenges inherent to the psychosocial informed physiotherapy treatment of patients classified with high risk of developing persistent and disabling pain. More specifically, they emphasised the need to receive mentoring sessions in clinical practice, in order to develop competences for the management of psychosocial issues.In what concerns to the potential facilitators to the implementation of the model, the participants` personal motivation was considered as one of the most important factors. The alignment of the SPLIT model with the mission and goals of the health care units where the project was going to be piloted was also identified as an important facilitator. Finally, both professionals groups considered that the SPLIT model may facilitate the interdisciplinary approach to the management of this condition, as it clarifies the specific contribution of GPs and PTs in the approach to LBP patientsConclusionThe knowledge about the potential barriers and facilitators to the implementation of the SPLIT stratified model of care may contribute to the successful implementation of stratified care for LBP patients ...