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 restoration of function and improved quality of life, which is measured by patient-reported outcomes. 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 = 217)

August 2016 – August 2019

Following completion of the Back on TREK program, participants’ scores on the Oswestry Disability Index improved from a baseline of approximately 46 to approximately 34.

Demographics in BoT Graduates (as of August 13, 2019), N = 309
Characteristic N (%)
Female 210 (68.0)
Initial STarT Score
1 22 (7.2)
2 121 (39.7)
3 162 (53.1)
Age, mean ± SD 54.5 ± 13.3
Range 20-86
Primary Language
English 283 (91.6)
Spanish 24 (7.8)
Arabic 2 (0.6)

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 BoT Graduates (as of August 13, 2019), N = 309
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 45.9 ± 16.1 33.8 ± 18.4 (-) 12.2 (0.8) 157/292 (53.8%) < 0.001
PHQ-9 Depressionᶜ 9.9 ± 6.6 6.8 ± 5.8 (-) 3.4 (0.4) 92/243 (37.9%) < 0.001
PROMIS Anxietyᶜ 60.1 ± 8.2 56.4 ± 9.3 (-) 3.8 (0.5) 96/245 (39.2%) < 0.001
PROMIS Fatigueᶜ 59.5 ± 9.4 55.3 ± 9.7 (-) 4.2 (0.5) 108/242 (44.6%) < 0.001
PROMIS Functional Status 36.1 ± 5.8 40.6 ± 7.6 4.8 (0.4) 111/248 (44.8%) < 0.001
PROMIS Global Mental Health 41.3 ± 9.3 43.3 ± 9.6 2.0 (0.5) 54/183 (29.5%) < 0.001
PROMIS Global Physical Health 36.2 ± 6.7 39.9 ± 7.8 4.3 (0.5) 74/181 (29.5%) < 0.001
PROMIS Pain Interferenceᶜ 65.6 ± 5.9 59.8 ± 8.0 (-) 6.1 (0.4) 132/245 (53.9%) < 0.001
PROMIS Sleep Disturbanceᶜ 59.2 ± 8.9 54.9 ± 10.4 (-) 4.5 (0.6) 105/244 (43.0%) < 0.001
PROMIS Social Role Satisfaction 39.1 ± 7.8 46.1 ± 10.2 7.2 (0.6) 140/246 (56.9%) < 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

P 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

Changes in Pain Catastrophizing in Back on TREK Program Participants

Pain catastrophizing is a cognitive and affective response to pain measured by 3 subscales: helplessness, magnification, and rumination.⁴

The mean score at the start of BoT is 20.3 (SD = 13.3) and at graduation it is 12.1 (SD = 10.8). This is a significant reduction of 8.3 points (P < 0.001).

References
  1. Keele University. STarT Back Screening Tool Website. http://www.keele.ac.uk/sbst/
  2. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008 May 15;59(5):632-641.
  3. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011 Oct 29;378(9802):1560-1571.
  4. Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebvre JC. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001 Mar;17(1):52-64.