Preliminary Evaluation of a Modified STarT Back Screening Tool Across Different Musculoskeletal Pain Conditions

Abstract Background The STarT Back Screening Tool is a validated multidimensional screening measure and risk stratification tool for people with low back pain. Objective The study objective was to compare relationships between a modified STarT Back Screening Tool (mSBT) and clinical and psychological measures in people with low back, neck, shoulder, and knee pain. The hypothesis was that the relationships between mSBT scores and clinical and psychological measure scores would be similar across the included musculoskeletal pain conditions. Design A cross-sectional, secondary analysis was done in this study. Methods Participants with low back (n=118), neck (n=92), shoulder (n=106), or knee (n=111) pain were recruited, and an mSBT was developed for use across the pain conditions. Separate hierarchical linear regression models were developed, with clinical (health status, pain intensity, and disability) and psychological (kinesiophobia, catastrophizing, fear avoidance, anxiety, depressive symptoms, and self-efficacy) measures as dependent variables. Demographic and pain region variables were entered in the first step, mSBT scores were entered in the second step, and pain region × mSBT interactions were entered in the last step. Results In the final models, no interactions were identified, suggesting that dependent measure scores did not differ by pain region. The strongest contributor for all dependent variables was mSBT scores (β=|0.32|–|0.68|); higher mSBT scores were associated with poorer health status and self-efficacy and with higher levels of pain intensity, disability, kinesiophobia, catastrophizing, fear avoidance, anxiety, and depressive symptoms. Limitations Generalizability was restricted to physical therapy outpatients with the included pain conditions. The mSBT used in this study is not ready for clinical implementation. Conclusions The results of this study support the feasibility of using a single measure for concise risk assessment across different musculoskeletal pain conditions. Further longitudinal studies are needed to better direct the clinical use of an mSBT in people with low back, neck, shoulder, and knee pain.

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Evaluation of the STarT Back Screening Tool for Prediction of Low Back Pain Intensity in an Outpatient Physical Therapy Setting

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2017.7284 ◽

2017 ◽

Vol 47 (4) ◽

pp. 261-267 ◽

Cited By ~ 4

Author(s):

Irene Toh ◽

Hwei-Chi Chong ◽

Jennifer Suet-Ching Liaw ◽

Yong-Hao Pua

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Pain Intensity ◽

Screening Tool ◽

Low Back ◽

Start Back Screening Tool

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Comparison of STarT Back Screening Tool and Simmonds Physical Performance Based Test Battery in Prediction of Disability Risks Among Patients with Chronic Low-Back Pain

Rehabilitacja Medyczna ◽

10.5604/01.3001.0013.0856 ◽

2019 ◽

Vol 22 (4) ◽

pp. 4-17

Author(s):

Chidozie Emmanuel Mbada (PhD PT) ◽

Aanuoluwapo Deborah Afolabi (MSc PT) ◽

Olubusola Esther Johnson (PhD PT) ◽

Adesola Christianah Odole (PhD PT) ◽

Taofik Oluwasegun Afolabi (MSc PT) ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Physical Performance ◽

Screening Tool ◽

Low Back ◽

Performance Tests ◽

Start Back Screening Tool ◽

Ceiling Effects ◽

The Mean

Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.

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The STarT Back Screening Tool and Individual Psychological Measures: Evaluation of Prognostic Capabilities for Low Back Pain Clinical Outcomes in Outpatient Physical Therapy Settings

Physical Therapy ◽

10.2522/ptj.20120207 ◽

2013 ◽

Vol 93 (3) ◽

pp. 321-333 ◽

Cited By ~ 88

Author(s):

Jason M. Beneciuk ◽

Mark D. Bishop ◽

Julie M. Fritz ◽

Michael E. Robinson ◽

Nabih R. Asal ◽

...

Keyword(s):

Low Back Pain ◽

Physical Therapy ◽

Pain Intensity ◽

Clinical Outcomes ◽

Regression Models ◽

Screening Tool ◽

Low Back ◽

Start Back Screening Tool ◽

Psychological Measures ◽

Psychological Measure

BackgroundPsychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted.ObjectiveThe purpose of this study was to test the predictive validity of the STarT Back Screening Tool (SBT) in comparison with single-construct psychological measures for 6-month clinical outcomes.DesignThis was an observational, prospective cohort study.MethodsPatients (n=146) receiving physical therapy for low back pain were administered the SBT and a battery of psychological measures (Fear-Avoidance Beliefs Questionnaire physical activity scale and work scale [FABQ-PA and FABQ-W, respectively], Pain Catastrophizing Scale [PCS], 11-item version of the Tampa Scale of Kinesiophobia [TSK-11], and 9-item Patient Health Questionnaire [PHQ-9]) at initial evaluation and 4 weeks later. Treatment was at the physical therapist's discretion. Clinical outcomes consisted of pain intensity and self-reported disability. Prediction of 6-month clinical outcomes was assessed for intake SBT and psychological measure scores using multiple regression models while controlling for other prognostic variables. In addition, the predictive capabilities of intake to 4-week changes in SBT and psychological measure scores for 6-month clinical outcomes were assessed.ResultsIntake pain intensity scores (β=.39 to .45) and disability scores (β=.47 to .60) were the strongest predictors in all final regression models, explaining 22% and 24% and 43% and 48% of the variance for the respective clinical outcome at 6 months. Neither SBT nor psychological measure scores improved prediction of 6-month pain intensity. The SBT overall scores (β=.22) and SBT psychosocial scores (β=.25) added to the prediction of disability at 6 months. Four-week changes in TSK-11 scores (β=−.18) were predictive of pain intensity at 6 months. Four-week changes in FABQ-PA scores (β=−.21), TSK-11 scores (β=−.20) and SBT overall scores (β=−.18) were predictive of disability at 6 months.LimitationsPhysical therapy treatment was not standardized or accounted for in the analysis.ConclusionsPrediction of clinical outcomes by psychology-based measures was dependent upon the clinical outcome domain of interest. Similar to studies from the primary care setting, initial screening with the SBT provided additional prognostic information for 6-month disability and changes in SBT overall scores may provide important clinical decision-making information for treatment monitoring.

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