Trial reportLancet (London, England)2011
Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.
Trial report in Lancet (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 532 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effectiveness of a Stratified Care Model for Non-specific Low Back Pain in Danish Primary Care Compared to Current Practice in a Randomised Controlled Trial
The Association Between STarT Back Tool Subgroups of Patients With Low Back Pain and Postural Stability Under Conditions of Sensory Deprivation and Cognitive Load
A Behavioural Medicine Approach in Physical Therapy for Treatment of Chronic Pain - Evaluation of the Implementation Process and Outcome
Validation of the STarT Back Screening Tool in the Primary Care Management of Low Back Pain in the Military Health System: A Randomized Trial of Risk-stratified vs. Usual Care
Pain Experience in Individuals With Chronic Low Back Pain: a Cohort Study
Task-sharing and Shifting Model Between Family Physicians and Physiotherapists for Acute Low Back Pain Patients: a Pragmatic Cluster Randomized Controlled Trial
Who cites it
532 citing papers in PubMed, 12 syntheses or guidelines pooled it, 1,301 citations in OpenAlex.
- The prognosis of pain and function in people with hand and thumb base osteoarthritis: a systematic review.Annals of medicine · 2025Pooled it
- Prognostic Factors and Models for Predicting Work Absence in Adults with Musculoskeletal Conditions Consulting a Healthcare Practitioner: A Systematic Review.Journal of occupational rehabilitation · 2025Pooled it
- Models of care for managing non-specific low back pain.The Cochrane database of systematic reviews · 2025Pooled it
- Cost-Effectiveness of Physiotherapy Services for Chronic Condition Management: A Systematic Review of Economic Evaluations Conducted Alongside Randomized Controlled Trials.Physiotherapy Canada. Physiotherapie Canada · 2024Pooled it
- Pooled it
- Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF).European journal of physical and rehabilitation medicine · 2024Guideline
- Research hotspots and frontiers in non-specific low back pain: a bibliometric analysis.Frontiers in neurology · 2024Pooled it
- How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Pooled it
- The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients.Journal of occupational rehabilitation · 2022Guideline
- Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness.Journal of public health (Oxford, England) · 2022Pooled it
- Psychological therapies for temporomandibular disorders (TMDs).The Cochrane database of systematic reviews · 2022Pooled it
- Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain.BMC musculoskeletal disorders · 2021Pooled it
- Sequenced Care Pathway vs Pain Navigator Pathway for Veterans With Low Back Pain: The AIM-Back Cluster Randomized Clinical Trial.JAMA network open · 2026Trial
- Where is the patient in the records? Evaluating physiotherapists' first visit in occupational health primary care pathway for low back pain.BMJ open quality · 2026Trial
- Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled Trial.The American journal of sports medicine · 2025Trial
- Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain).Journal of occupational rehabilitation · 2025Trial
- Capabilities, opportunities and motivations in implementing guideline-oriented biopsychosocial low back pain management: perceptions of occupational healthcare professionals after an educational intervention.BMC health services research · 2025Trial
- Trial
- Supporting self-management with an internet intervention for low back pain in primary care: a RCT (SupportBack 2).Health technology assessment (Winchester, England) · 2025Trial
- Risk-stratified Care Improves Pain-related Knowledge and Reduces Psychological Distress for Low Back Pain: A Secondary Analysis of a Randomized Trial.Clinical orthopaedics and related research · 2025Trial
472 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundBack pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control).
methods1573 adults (aged ≥18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. This study is registered, number ISRCTN37113406.
findings851 patients were assigned to the intervention (n=568) and control groups (n=283). Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4·7 [SD 5·9] vs 3·0 [5·9], between-group difference 1·81 [95% CI 1·06-2·57]) and at 12 months (4·3 [6·4] vs 3·3 [6·2], 1·06 [0·25-1·86]), equating to effect sizes of 0·32 (0·19-0·45) and 0·19 (0·04-0·33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01 vs £274·40) compared with the control group.
interpretationThe results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care.
fundingArthritis Research UK.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.