BACKGROUND Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients' understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care. METHODS We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up. DISCUSSION The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway. TRIAL REGISTRATION ISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.

中文翻译：

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基于分类的初级保健中腰痛的方法-基准对照试验的方案。

背景技术指南推荐了用于腰背痛（LBP）管理和避免不适当成像的生物心理社会框架。在临床实践中，即使LBP是全球最常见的致残性健康状况，其护理策略也常常与证据和指南不一致。无益的信念，态度和不恰当的想象是很常见的。LBP被认为是一种复杂的生物心理社会现象，具有许多已知的持续或长期残疾的多维风险因素（与症状和生活方式有关的心理和社会风险），应通过治疗加以识别和解决。开发了STarT Back Tool（SBT），用于及早发现LBP的个体危险因素，以实现针对性的护理。已经证明，根据SBT进行的分层护理可以改善初级护理环境中的护理效果。面向生物心理社会的患者教育手册（包括成像指南和信息）是增加患者对LBP理解并减少不适当成像的一种可能方法。在医疗保健组织中，预先确定的途径，专业人员的教育，书面材料以及电子患者注册表支持可以帮助实施循证护理。方法我们将在研究中使用基准对照试验（BCT）设计。在对初级保健中的LBP采用基于分类的方法之前和之后，我们将前瞻性地从三个卫生保健地区收集数据。主要结果将是在12个月的随访中PROMIS（患者报告的结果测量信息系统）（缩写为20a）的变化。讨论实施基于分类的生物社会心理方法可以潜在地改善LBP患者的护理，减少不适当的影像而不增加医疗保健成本，并通过减少工作残疾来减少间接成本。使用BCT，我们将能够评估整个护理途径的改善策略的有效性。试用注册号ISRCTN，ISRCTN13273552，追溯注册于2019年5月13日。并通过减少工作障碍来减少间接成本。使用BCT，我们将能够评估整个护理途径的改善策略的有效性。试用注册号ISRCTN，ISRCTN13273552，追溯注册于2019年5月13日。并通过减少工作障碍来减少间接成本。使用BCT，我们将能够评估整个护理途径的改善策略的有效性。试用注册号ISRCTN，ISRCTN13273552，追溯注册于2019年5月13日。