scholarly journals The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis – a population based cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Emma Haglund ◽  
Ann Bremander ◽  
Stefan Bergman
Keyword(s):  
At Risk ◽  
Back Pain ◽  
High Risk ◽  
Chronic Widespread Pain ◽  
Screening Tools ◽  
Treatment Level ◽  
Start Back Screening Tool ◽  
Appropriate Treatment ◽  
Reported Health ◽  
Worse Prognosis

Abstract Background The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods One hundred and nineteen individuals (aged 40–71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin – as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0–18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Results Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - < 0.001). Conclusions Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT.

Screening Tools to Predict the Development of Chronic Low Back Pain: An Integrative Review of the Literature

Pain Medicine ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. 1651-1677 ◽  
Author(s):  
Jena Pauli ◽  
Angela Starkweather ◽  
Jo Lynne Robins
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Predictive Power ◽  
Screening Tools ◽  
Low Back ◽  
Start Back Screening Tool ◽  
Subacute Low Back Pain ◽  
Örebro Musculoskeletal Pain Questionnaire ◽  
Abstract Content

AbstractObjectiveTo identify and describe available instruments that can be used to screen patients with acute or subacute low back pain for a chronic low back pain trajectory.DesignIntegrative literature review.MethodsAn electronic search of PubMed/MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and PsychINFO databases took place from May through July of 2014 using systematic search strategies to identify screening instruments developed to identify people at risk of chronic low back pain. After screening for inclusion and exclusion criteria as well as quality indicators, the identified studies were categorized based on whether the instrument measured psychological, clinical, or functional measures to predict chronic low back pain.ResultsInitial searches identified 2,274 potential articles. After assessing for duplicates, title, and abstract content, there were 129 remaining articles. Articles were further excluded after analysis of the text, for a total of 42 studies reviewed. Most instruments reviewed were unable to provide evidence of predictive power for developing chronic low back pain.ConclusionsThis review identified numerous instruments developed to assess the likelihood of chronic low back pain in acute and subacute low back pain populations. Of the instruments reviewed, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire demonstrated superior predictive power compared with other instruments. Both screening tools offer evidence of validation, translation into different languages and international application, and usage in various health care settings and provide data on predictive power.

scholarly journals Triage-based care of people with Back Pain: STarT Back or Start diagnosing? An observational study.

2019 ◽  
Author(s):  
Tim Germon ◽  
Alex Jack ◽  
Jeremy Hobart
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
High Risk ◽  
Observational Study ◽  
Public Health Problem ◽  
Behavioural Therapy ◽  
Lumbar Pain ◽  
Score Distribution ◽  
Surgical Interventions ◽  
Start Back Screening Tool

Objectives Back pain is a massive public health problem. The STarT Back Screening Tool (SBST) was developed for use in primary care to triage people with lumbar pain, classifying them as low, medium or high risk of prolonged symptoms. This classification guides non-surgical interventions including manual treatments, exercise and cognitive behavioural therapy. Claims suggest SBST brings generic health and cost benefits. National guidance recommends STarT Back is used at the first primary care consultation but can be used at any stage. For SBST to be an effective triage tool it should distinguish structural from non-structural pain. We tested this requirement in consecutive people referred to a single triage practitioner, hypothesising it was not possible conceptually. Design An observational study of the relationship between routine, prospectively collected triage data and diagnosis. Setting A secondary care spinal triage service based in a teaching hospital. Participants We studied consecutive referrals with lumbar pain triaged by a single extended scope practitioner (ESP) over 22 months (Nov 2015-Sept 2017). Main Outcome Measures SBST and pain visual analogue scores (VAS: 0-10) were collected at the initial consultation. We compared data for people with and without surgically remedial lesions. Results 1041 people were seen (61% female, mean age 53), n=234 (28%) had surgically amenable explanations for pain. People with surgical lesions were older (58 v 51yrs), more likely male (48 v 35%) and had higher VAS scores (6.8 v 6.1). Surgery and non-surgery subgroups had similar SBST total and domain score distribution profiles. The surgery subgroup had less low risk (9%v21%) and more high risk (37% v 30%) classified people. Conclusion SBST scores did not differentiate surgical from non-surgical pathologies. It seems unlikely that symptom questionnaires can estimate prognosis accurately unless everyone has the same diagnosis, not just the same symptom. Diagnosis, rather than questionnaire scores, should guide treatment and inform prognosis.

scholarly journals Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain?

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 536
Author(s):  
Takahiro Tsuge ◽  
Hiroshi Takasaki ◽  
Michio Toda
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
High Risk ◽  
Management Strategy ◽  
Screening Tool ◽  
Low Back ◽  
Start Back Screening Tool ◽  
Independent Variables ◽  
Diagnosis And Therapy

Background: Mechanical diagnosis and therapy (MDT) and the stratified approach using the Keele STarT Back Screening Tool (SBST) are examples of stratified low back pain (LBP) management. We investigated whether the medium–high risk in SBST can contribute to the time and sessions until discharge from MDT (Question 1) and to the loss of follow-up before identifying a promising management strategy (Question 2). Methods: A retrospective chart study was conducted. Multiple regression modeling was constructed using 10 independent variables, including whether the SBST was medium–high risk or not for Question 1, and the 9/10 independent variables for Question 2. Results: The data of 89 participants for Question 1 and 166 participants for Question 2 were analyzed. SBST was not a primary contributing factor for Question 1 (R2 = 0.17–0.19). The model for Question 2 included SBST as a primary contributing factor and the shortest distance from the patient address to the hospital as a secondary contributing factor (93.4% correct classification). Conclusion: SBST status was not a primary contributing factor for time and sessions until discharge from MDT, but was a critical factor for the loss of MDT follow-up before identifying a promising management strategy.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

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