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Stepped Care for Back Pain: Activating Approaches for Primary Care

Michael Von Korff, ScD; and James C. Moore, PhD
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From the Group Health Cooperative and Virginia Mason Medical Center, Seattle, Washington. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Grant Support: In part by grant P01 DE08773 from the National Institutes of Health.

Requests for Reprints: Michael Von Korff, ScD, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101; e-mail, vonkorff.m@ghc.org.

Current Author Addresses: Dr. Von Korff: Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.

Dr. Moore: Section of Physical Medicine and Rehabilitation, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101.

Ann Intern Med. 2001;134(9_Part_2):911-917. doi:10.7326/0003-4819-134-9_Part_2-200105011-00016
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Interventions that encourage return to normal function and reduce fear of physical activity have been shown to improve outcomes for patients with back pain, but routine medical care for back pain often does not provide such interventions. This paper proposes a stepped-care approach that addresses the functional outcomes of back pain. Step 1, which is relevant to most patients, addresses the common fears of patients with back pain and encourages patients to resume normal activities. Step 2, which targets the substantial minority of patients who require more than simple advice to resume activities, provides brief, structured interventions that support physical exercise and return to normal activities. Step 3 targets patients who require more intensive interventions, including treatment of psychological illness when present, before they can return to normal activities in work and family life. Patient needs relevant to these three levels of care are delineated. This stepped-care approach provides a framework for sequencing progressively more intensive interventions and coordinating the efforts of primary care physicians, allied health professionals, behavioral health clinicians, and patients to improve functional outcomes in patients with back pain.





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