0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Innovations in Symptom Management |

Stepped Care for Back Pain: Activating Approaches for Primary Care

Michael Von Korff, ScD; and James C. Moore, PhD
[+] Article and Author Information

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
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)