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. TRIAL REGISTRATION ISRCTN 15366334.

中文翻译：

---

肌肉骨骼疼痛的分层初级护理与非分层护理：STarT MSK 可行性和试点集群随机对照试验的定性研究结果。


背景技术分层护理涉及根据关键特征（例如预后风险）对患者进行亚组，并将这些亚组与适当的早期治疗方案相匹配。 STarT MSK 可行性和试点整群随机对照试验 (RCT) 检查了未来主要试验的可行性以及为肌肉骨骼疼痛患者提供预后分层初级护理的可行性。试点随机对照试验在英国 8 个全科诊所（4 个分层护理；4 个常规护理）中进行，涉及 524 名患者。分层护理实践中的全科医生被要求使用 i) Keele STarT MSK 开发工具进行风险分层，以及 ii) 为持续性疼痛的低、中和高风险患者提供匹配的治疗方案。本文报告了一项嵌套定性研究，探讨在主要试验之前提供分层护理的可行性。方法 根据咨询录音，对分层护理组中的患者和全科医生（n = 10 名患者；10 名全科医生）进行“刺激回忆”访谈。对数据进行主题分析并映射到 COM-B 行为改变模型；探索能力、机会和动机 全科医生和患者必须接受分层护理。结果 患者报告了积极的观点，认为分层护理可以实现更加“结构化”的咨询，并认为工具项目有助于让全科医生了解患者的忧虑和担忧。然而，该工具项目的封闭性被视为开放讨论的障碍。全科医生发现将该工具整合到咨询中存在困难（机会），但随着它变得更加熟悉，这变得更容易。虽然两个小组都认为该工具具有附加值，但他们发现“繁琐”的项目使其更难以使用（功能）。 大多数全科医生报告说，匹配的治疗方案有助于他们的临床决策（动机），但也发现了一些他们无法使用的选项（例如疼痛管理诊所），以及其他未包含在匹配治疗中但感觉良好的选项适合某些患者（例如考虑影像学检查）。结论 这项嵌套定性研究使用 COM-B 模型，确定了主要试验所需的修改，包括对 Keele STarT MSK 工具和匹配治疗方案的更改，针对 COM-B 模型结构，并且这些已在当前的主要试验中实施。审判。试用注册 ISRCTN 15366334。