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
CharacteristicN (%)
Female259 (68)
Initial STarT score
Age, mean ± SD6.2 ± 1.9
Range19-87
Marital status
Married172 (45.1)
Single146 (38.3)
Divorced41 (10.8)
Widowed14 (3.7)
Unknown8 (2.1)
Days in BoT, mean ± SD93.4 ± 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 ± SD3 Month Score Mean ± SDChange in Score Mean (SE)Clinically Significant Change N (%)ᵃP Value for Changeᵇ
Oswestry Disability Indexᶜ46.6 ± 15.734.8 ± 18.3(-) 11.8 (0.8)172/334 (51.5%)< 0.001
PHQ-9 Depressionᶜ10.2 ± 6.56.7 ± 5.7(-) 3.8 (0.4)98/258 (38%)< 0.001
Pain Catastrophizing Scaleᶜ21.9 ± 13.311.1 ± 11.1(-) 9.5 (1.4)40/63 (63.5%)< 0.001
PROMIS® Anxietyᶜ60 ± 8.155.8 ± 9.6(-) 4.2 (0.4)115/279 (41.2%)< 0.001
PROMIS Fatigueᶜ59.5 ± 9.455.3 ± 10(-) 4.4 (0.5)127/270 (47%)< 0.001
PROMIS Pain Interferenceᶜ65.9 ± 5.960 ± 7.9(-) 6.3 (0.4)150/275 (54.5%)< 0.001
PROMIS Sleep Disturbanceᶜ59.1 ± 8.854.5 ± 10.6(-) 4.8 (0.5)123/278 (44.2%)< 0.001
PROMIS Physical Function35.9 ± 5.840.4 ± 7.54.8 (0.4)127/284 (44.7%)< 0.001
PROMIS Social Role Satisfaction38.8 ± 7.645.9 ± 10.17.2 (0.6)160/284 (56.3%)< 0.001
PROMIS Global Mental Health40.9 ± 9.243.2 ± 9.22.9 (0.5)54/163 (33.1%)< 0.001
PROMIS Global Physical Health36.2 ± 6.339.8 ± 7.74.1 (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

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

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.
  5. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001 Feb;81(2):776-788.
  6. Craig BM, Reeve BB, Brown PM, Cella D, Hays RD, Lipscomb J, Pickard AS, Revicki DA. US valuation of health outcomes measured using the PROMIS-29. Value Health. 2014 Dec;17(8):846-853.