Professor Nadine Foster, of the Arthritis Research UK Primary Care Centre at Keele University, Staffordshire, UK, has been awarded an National Institute for Health Research Health Technology Assessment grant of £1.18 million for a randomised trial that seeks to improve the primary care management of patients with sciatica and suspected sciatica through a new approach called stratified care.
"Sciatica" and "suspected sciatica" describe patients who have back-related leg pain or other leg symptoms such as pins and needles or muscle weakness, most likely due to compression or irritation of spinal nerve roots. Sciatica has a significant impact on patients; pain can lead to problems with everyday activities, including time off work, and even unemployment. Whilst many patients have mild problems, a substantial proportion (estimated at up to 30%) suffer with pain for a year or more and incurs considerable costs.
In current practice, patients with sciatica and suspected sciatica tend to be managed in primary care with a 'wait-and-see' approach, with some patients eventually being referred to other professionals such as physiotherapists for help with pain and function or to spinal specialists including pain specialists and orthopaedic surgeons. Currently there is no UK National Institute of Health and Clinical Excellence (NICE) guidance about the best way to treat sciatica patients and little previous research specifically on this patient population.
The new stratified care approach combines systematic information about individual patients' likelihood of recovery (their prognosis) with information from their clinical history and physical examination in order to better ensure that the patient gets the right treatment.
Using a systematic process that combines information about each patient's likelihood of a poor outcome and the presence of important clinical indicators, patients with sciatica and suspected sciatica who consult in primary care will be grouped into one of three subgroups (low, medium and high risk) and matched to appropriate treatments.
Over four years, the research team, which includes Dr Kika Konstantinou, Prof Danielle van der Windt, Prof Kate Dunn, Prof Christian Mallen, Prof Elaine Hay, Dr Martyn Lewis, Dr Jonathan Hill, Dr Majid Artus, Dr Tom Sanders and Dr Sue Jowett working in partnership with NHS colleagues and the Primary Care Research Network, will conduct a randomised trial with 470 patients who consult in primary care with sciatica and suspected sciatica, and include linked interviews with patients and clinicians.
They will test whether stratified care leads to faster recovery for patients than usual, non-stratified care, whether it leads to better outcomes at four and 12 months follow-up, whether it is acceptable to patients and clinicians, whether it changes the proportions of patients who access appropriate treatments for their profile, and whether it is cost-effective for the NHS to adopt more widely.
The study is called 'Stratified Care for Patients with Sciatica and Suspected Sciatica in Primary Care: A randomised trial' (the SCOPiC trial - SCiatica Outcomes in Primary Care). The strong partnership betweeen the primary care centre at Keele with NHS partners from Staffordshire and Shropshire has been key to the success in securing this grant and it is this engagement that will support the development and delivery of the trial.