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In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients\u2019 understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p><jats:bold>ISRCTN,<\/jats:bold><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1186\/ISRCTN13273552\">ISRCTN13273552<\/jats:ext-link>, retrospectively registered 13\/05\/2019.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-020-01135-8","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T13:03:32Z","timestamp":1586178212000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A classification-based approach to low back pain in primary care \u2013 protocol for a benchmarking controlled trial"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-4892","authenticated-orcid":false,"given":"A. 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Pain. 2018;159:481\u201395.","journal-title":"Pain"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-020-01135-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12875-020-01135-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-020-01135-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T23:06:23Z","timestamp":1617663983000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-020-01135-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,6]]},"references-count":49,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1135"],"URL":"https:\/\/doi.org\/10.1186\/s12875-020-01135-8","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,6]]},"assertion":[{"value":"3 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study is approved by the Ethics Committee of the University Hospital of Oulu, Finland (109\/2016), and will be performed in accordance with the Declaration of Helsinki. The final approval date was 23rd January, 2017 and all the participants will provide informed written consent. All the participating health care regions have approved the study. Main topics of the study include: 1) avoidance of inappropriate imaging; 2) systematic identification of psychosocial risk factors and individual risk-based treatment plans; 3) avoidance of nocebo messages; 4) improvement in the delivery to patients of evidence-based, correct information; 5) enhancement of therapeutic alliance and support of self-efficacy; and 6) emphasis on physiotherapists\u2019 role in rehabilitation. The aim is to implement the research results into everyday practice, which will require great effort. As it would be ethically wrong to disallow normal improvement strategies within organizations during the study, we will use the Benchmarking Controlled Trial (BMCT) as our design, which allows each area to act as its own control before and after implementation. This will enable evaluation of the differences between the areas and development of the care strategies during the process. The participants will be informed of the aim of the study, the eligibility criteria, the progress of the study, and the risks and benefits. They will be informed that participation in the study is voluntary and will not influence their treatment decisions in the health care region. Personal information will be kept in secured facilities and replaced with ID codes for analyses.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"A-SS, AM and JK: Payments for talks or clinical workshops related to a biopsychosocial approach for LBP care from organizations or clinics outside of the current study. NB has no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"61"}}