Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis - 18/04/17
, Jonathan C. Hill ‡, Paul Campbell ‡, Ebenezer Afolabi ‡, Steven Z. George ∗, †, Kate M. Dunn ‡, Nadine E. Foster ‡Abstract |
Identification of patient characteristics influencing treatment outcomes is a top low back pain (LBP) research priority. Results from the STarT Back trial support the effectiveness of prognostic stratified care for LBP compared with current best care, however, patient characteristics associated with treatment response have not yet been explored. The purpose of this secondary analysis was to identify treatment effect modifiers within the STarT Back trial at 4-month follow-up (n = 688). Treatment response was dichotomized using back-specific physical disability measured using the Roland-Morris Disability Questionnaire (≥7). Candidate modifiers were identified using previous literature and evaluated using logistic regression with statistical interaction terms to provide preliminary evidence of treatment effect modification. Socioeconomic status (SES) was identified as an effect modifier for disability outcomes (odds ratio [OR] = 1.71, P = .028). High SES patients receiving prognostic stratified care were 2.5 times less likely to have a poor outcome compared with low SES patients receiving best current care (OR = .40, P = .006). Education level (OR = 1.33, P = .109) and number of pain medications (OR = .64, P = .140) met our criteria for effect modification with weaker evidence (.20 > P ≥ .05). These findings provide preliminary evidence for SES, education, and number of pain medications as treatment effect modifiers of prognostic stratified care delivered in the STarT Back Trial.
Perspective |
This analysis provides preliminary exploratory findings about the characteristics of patients who might least likely benefit from targeted treatment using prognostic stratified care for LBP.
Le texte complet de cet article est disponible en PDF.Highlights |
• | We conducted a secondary analysis to identify treatment effect modifiers within the STarT Back trial at 4-month follow-up. |
• | Socioeconomic status was identified as an effect modifier for disability outcomes with education level and number of pain medications meeting criteria for effect modification with weaker evidence. |
• | We have provided preliminary exploratory findings about characteristics of patients who might least likely benefit from prognostic stratified care treatment for low back pain. |
Key words : Low back pain, socioeconomic status, treatment effect modification, stratified care, subgrouping
Plan
| Jason M. Beneciuk was supported by the American National Institutes of Health Rehabilitation Research Career Development Program (K12-HD055929). Nadine E. Foster and Jonathan C. Hill are supported through a United Kingdom National Institute for Health Research (NIHR). Research Professorship awarded to Nadine E. Foster (NIHR-RP-011-015). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institutes of Health, the National Institute for Health Research, or the Department of Health. |
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| The authors have no conflicts of interest to declare. |
Vol 18 - N° 1
P. 54-65 - janvier 2017 Retour au numéro
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