STEPPT: Connecting primary care patients with physical therapy
Stratified Targeted Engagement From Primary Care to Physical Therapy (STEPPT): A Pragmatic Stepped Wedge Cluster Randomized Trial
This project will test whether the STEPPT program increases physical therapy referrals and attendance for Hispanic adults with neck or back pain seen at a community health center.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 17587 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | San Diego State University Academic / other |
| Locations | 1 site (San Diego, California) |
| Trial ID | NCT07290361 on ClinicalTrials.gov |
What this trial studies
STEPPT is a clinic-level intervention that trains primary care providers and staff to promote physical therapy and delivers culturally tailored handouts and videos to patients. The trial uses a pragmatic stepped-wedge cluster randomized design across nine Federally Qualified Health Center (FQHC) clinics, with clinics transitioning from usual care to STEPPT in three steps at six-month intervals. Primary outcomes are rates of physical therapy referral and patient adherence after referral, and secondary analyses will examine implementation measures of fidelity and reach. The intervention targets improvement in access and engagement for underserved Hispanic patients with spine pain in a real-world primary care setting.
Who should consider this trial
Good fit: Adults (18+) who identify as Hispanic or non-Hispanic, present to a participating FQHC primary care clinic with a new or existing neck or back pain problem, and have signed broad consent for use of de-identified health data are eligible.
Not a fit: Patients whose spine pain is due to non-musculoskeletal causes (e.g., infection, cancer, pregnancy) or who require urgent medical intervention, or who do not receive care at the participating clinics, are unlikely to benefit from STEPPT.
Why it matters
Potential benefit: If successful, STEPPT could increase referrals and attendance to physical therapy for Hispanic patients with spine pain, improving access to conservative care and potentially reducing pain and downstream healthcare use.
How similar studies have performed: Previous work shows that primary-care to physical therapy pathways and stratified engagement can improve referral and outcomes, but the use of culturally tailored materials for underserved Hispanic populations within a stepped-wedge implementation is relatively novel.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria * 18 years or older. * Identify as either Hispanic or Non-Hispanic ethnicity, inclusive of all races. * Seeking care for spine pain at an Adult or Adult Walk-in primary care clinic within the participating Federally Qualified Health Center (FQHC). * New or existing spine pain problem: A new spine pain problem is defined by a new ICD code for neck or back pain added to the problem list during a visit with a primary care physician. An existing spine pain problem is defined by an existing ICD code for neck or back pain on the problem list that is associated with a physician referral for any service during the visit related to the neck or back pain problem. * Signed a broad consent for the use of de-identified health information for research at the participating FQHC. Exclusion Criteria: * Spine pain associated with a non-musculoskeletal etiology (e.g., infection, cancer, urological disorders, pregnancy, etc.) * Patients requiring urgent medical intervention (e.g., fracture, cauda equina syndrome, etc) * Active physical therapy referral for spine pain at the time of the index encounter. * Previously referred to physical therapy through the STEPPT Care Pathway. * Physical therapy referrals external to the FQHC will be excluded from the analysis of physical therapy adherence
Where this trial is running
San Diego, California
- Family Health Centers of San Diego — San Diego, California, United States (Recruiting)
Study contacts
- Principal investigator: Katrina Monroe, PT, PhD — San Diego State University
- Study coordinator: Cheenee R Real, BSN, MPH, MSOL
- Email: creal2@sdsu.edu
- Phone: 323-508-6312
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.