Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Reviewers’ comments and the investigator’s changes in response included the following:

  • The awardee addressed reviewers’ confusion about the timing of this study in the context of a larger, system-wide initiative to change low back pain care within Group Health Cooperative (now Kaiser Permanent Washington). The awardee explained that the dissemination of the system-wide initiative was passive. The investigator noted that the initiative was not mandatory but it represented usual care in the comparison clinics. The awardee explained that it implemented the quality improvement intervention, STarT Back, only in the three study clinics, which required training for physicians and other staff.
  • In response to reviewer questions, the awardee explained that stakeholder engagement was influential in deciding on outcome measures and messaging for study participants but was not a factor in the design of the study. The awardee noted that the stakeholders did not have expertise in study design.
  • The reviewers noted that the 12-day span between participants’ study entry and baseline data collection could have allowed for patients to improve before the collection of baseline data, resulting in the intervention’s small effect size. The awardee acknowledged this as a limitation of the study.
  • The reviewers asked the awardee to add information to the background and discussion sections describing similarities and differences between the current study and a previous study of the same intervention in the United Kingdom. The awardee posited possible reasons that patients receiving the intervention showed improvement in the United Kingdom but not in the United States. The investigator based its reasoning on differences in healthcare structure in the two countries. The awardee also noted that the UK intervention primarily focused on physical therapy, rather than the multiple treatment options in the current study. The awardee also noted that in the current study, patients had more disability related to low back pain than patients did in the UK study.

Conflict of Interest Disclosures

Project Information

Dan Cherkin, PhD, MS
Kaiser Foundation Health Plan of Washington^
$1,946,346
10.25302/11.2018.CER.398
Evaluation of a Patient-Centered Risk Stratification Method for Improving Primary Care for Back Pain

Key Dates

December 2012
July 2018
2012
2018

Study Registration Information

^Group Health Cooperative was aquired by Kaiser Permanente in February 2017.

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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: March 4, 2022