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This study was done to compare the efficiency and cost-effectiveness of stratified care and usual care.
From a recent study, it
was concluded that the stratified care was not more effective than usual care
for sciatica. Moreover, it was not cost-effective. Patients in the usual care
group have not shown promising outcomes. Therefore, it was not easy to exhibit
the advantage of stratified care.
This study was done to
compare the efficiency and cost-effectiveness of stratified care and usual
care.
The participants in this
study were not above 18 years of age who had suspected sciatica and were not
getting treatment for it, nor they had earlier spinal surgery. In stratified
care, patients were divided into three groups. Group 1 was given advice and
maximum of two sessions of physiotherapy, group 2 was given maximum six
sessions of physiotherapy, and group 3 was accelerated to MRI and specialist
opinion. Usual care was done using the stepped-care approach. Patients were
grouped with the help of remote web-based randomisation service.
The primary result
included first resolution time of sciatica symptoms. The secondary result
involved pain, function, days missing from a job, emotional health, work
productivity, health-care use and satisfaction with care. A cost-utility
investigation was carried out for more than 12 months.
There were 476 patients in this study, who were sub-grouped into 238 each. For the main result, the general response rate was 89.3%. stratified care group achieved faster relief from symptoms. However, the variation was not statistically considerable. On average, patients in both groups showed fair progression from baseline, on the majority of results with time. After clinical research, most patients in the usual group were recommended for physiotherapy.
Table- Response
rate
The stratified care has
not shown added efficiency, nor it was cost-effective. The accelerated pathway
was believed to be satisfactory to both clinicians and patients.
Health Technology Assessment
Stratified versus usual care for the management of primary care patients with sciatica: the SCOPiC RCT
Nadine E Foster et al.
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