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 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
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
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).
