SCOPIC

Study design

Randomised Controlled Trial

Primary objective

To improve the primary care management of patients consulting with sciatica through a new approach called stratified care which addresses two components; 1) clearer identification and subgrouping of patients with different characteristics 2) matching of patient subgroups to different treatments. It includes early identification of patients who are most likely to benefit from referral to spinal specialists.

This approach combines information about individual patients' likelihood of recovery (prognostic information) with information from their clinical history and physical examination (clinical indicators of the severity of sciatica) in order to ensure that the right patient gets the right treatment at the right time. Using this systematic procedure, patients with sciatica are grouped into one of three subgroups (referred to as low, medium and high risk) and matched to appropriate and timely treatments with patients at low risk receiving advice and support to self-manage; those at medium risk receiving a course of physiotherapy treatment, and those at high risk being ‘fast-tracked’ (with MRI scan) to spinal specialists. The trial aims to recruit 470 patients and will test whether stratified care leads to faster recovery for patients than usual, non-stratified care, whether it leads to better outcomes at 4 and 12 months follow-up, and whether it is cost-effective for the NHS to adopt more widely.

A linked qualitative study will determine the acceptability of the ‘fast-track’ pathway to both patients and clinicians.

Interventions

Participants will be randomised to stratified care or usual care. Patients randomised to the usual care arm will be given advice by a physiotherapist who will direct their treatment accordingly and as per current practice. Patients randomised to the stratified care arm will be allocated to 1 of 3 subgroups based on a predefined treatment pathway algorithm: those at low risk will receive advice and support to self-manage; those at medium risk will receive a course of physiotherapist-led treatment.