Neurological Institute Outcomes
Pain
Back on TREK (Transform, Restore, Empower, Knowledge)
Back on TREK is a 10-week interdisciplinary program that focuses on helping individuals with chronic back pain to improve functioning and reduce pain and stress through physical therapy and behavioral medicine sessions. Care is also concurrently coordinated with spine medicine. This program requires a time commitment of 2 to 3 days per week. The key outcomes include decreased pain catastrophizing, restoration of function and improved quality of life, which are measured by patient-reported outcomes.¹⁻⁶ Patients are also educated on decreasing reliance on addictive medications for pain relief, including narcotics.
Change in Disability Following Back on TREK Program Participation (N = 381)
August 2016 – December 2020
Following completion of the Back on TREK program, participants’ scores on the Oswestry Disability Index improved from a baseline of approximately 47 to approximately 35.
Demographics in Back on TREK Graduates (as of December 31, 2020), N = 381
| Characteristic | N (%) |
|---|---|
| Female | 259 (68) |
| Initial STarT score | |
| Age, mean ± SD | 6.2 ± 1.9 |
| Range | 19-87 |
| Marital status | |
| Married | 172 (45.1) |
| Single | 146 (38.3) |
| Divorced | 41 (10.8) |
| Widowed | 14 (3.7) |
| Unknown | 8 (2.1) |
| Days in BoT, mean ± SD | 93.4 ± 25 |
BoT = Back on TREK, SD = standard deviation
The Keele STarT Back Screening Tool is a brief, validated measure designed to stratify patients with low back pain in low, medium, and high risk categories for persistent disabling pain.¹⁻³
Outcomes in Back on TREK Graduates (as of December 31, 2020), N = 381
| Baseline Score Mean ± SD | 3 Month Score Mean ± SD | Change in Score Mean (SE) | Clinically Significant Change N (%)ᵃ | P Value for Changeᵇ | |
|---|---|---|---|---|---|
| Oswestry Disability Indexᶜ | 46.6 ± 15.7 | 34.8 ± 18.3 | (-) 11.8 (0.8) | 172/334 (51.5%) | < 0.001 |
| PHQ-9 Depressionᶜ | 10.2 ± 6.5 | 6.7 ± 5.7 | (-) 3.8 (0.4) | 98/258 (38%) | < 0.001 |
| Pain Catastrophizing Scaleᶜ | 21.9 ± 13.3 | 11.1 ± 11.1 | (-) 9.5 (1.4) | 40/63 (63.5%) | < 0.001 |
| PROMIS® Anxietyᶜ | 60 ± 8.1 | 55.8 ± 9.6 | (-) 4.2 (0.4) | 115/279 (41.2%) | < 0.001 |
| PROMIS Fatigueᶜ | 59.5 ± 9.4 | 55.3 ± 10 | (-) 4.4 (0.5) | 127/270 (47%) | < 0.001 |
| PROMIS Pain Interferenceᶜ | 65.9 ± 5.9 | 60 ± 7.9 | (-) 6.3 (0.4) | 150/275 (54.5%) | < 0.001 |
| PROMIS Sleep Disturbanceᶜ | 59.1 ± 8.8 | 54.5 ± 10.6 | (-) 4.8 (0.5) | 123/278 (44.2%) | < 0.001 |
| PROMIS Physical Function | 35.9 ± 5.8 | 40.4 ± 7.5 | 4.8 (0.4) | 127/284 (44.7%) | < 0.001 |
| PROMIS Social Role Satisfaction | 38.8 ± 7.6 | 45.9 ± 10.1 | 7.2 (0.6) | 160/284 (56.3%) | < 0.001 |
| PROMIS Global Mental Health | 40.9 ± 9.2 | 43.2 ± 9.2 | 2.9 (0.5) | 54/163 (33.1%) | < 0.001 |
| PROMIS Global Physical Health | 36.2 ± 6.3 | 39.8 ± 7.7 | 4.1 (0.5) | 66/161 (41%) | < 0.001 |
PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System, SD = standard deviation, SE = standard error
ᵃClinically significant change defined as reduction of 10 points for Oswestry Disability Index and 5 points for all other measures
ᵇP value from paired t-test
ᶜLower scores indicate better outcomes.
Patients With Clinically Significant Improvement From Baseline to Graduation
PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System
