COMPARISON BETWEEN START BACK SCREENING TOOL AND DRAM FOR DETECTION OF PSYCHOSOCIAL FACTORS IN LOW BACK PAIN

ABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as “normal”, 32.1% as “at risk” and 48.8% as “distressed”. According to SBST, 59.5% of patients were classified as “low risk”, 31% as “medium risk” and 9.5% as “high risk”. Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.

Influência do protagonismo do paciente no tratamento fisioterapêutico da dor crônica na coluna vertebral

Este estudo buscou descrever o perfil sociodemográfico de pacientes de fisioterapia com dor crônica (DC) na coluna vertebral (CV) e a relação psicossocial com o protagonismo após a realização de exercícios físicos. Estudo exploratório-descritivo, de intervenção, com análise quantitativa dos dados, realizado na Clínica Escola de Fisioterapia (CEF) da Universidade do Vale do Taquari - Univates, Lajeado, RS. A coleta de dados se deu por questionário de identificação e os protocolos Start Back Screening Tool (SBST), Fear Avoidance Belief Questionnaire (FABQ), Questionário de Qualidade de Vida SF-36 e Índice Oswestry de Incapacidade (IOI). Participaram nove pacientes com DC na CV, sendo alocados em grupos: intervenção, participou de um grupo de promoção à saúde durante quatro semanas, duas vezes na semana, para a realização de exercícios na CEF; controle, recebeu cartilha com os mesmos exercícios para serem realizados no domicílio pelo mesmo período. Ambos os grupos apresentaram melhora no SF-36, SBST e IOI. No FABQ, apresentaram melhora no item atividade física e piora no trabalho. Conclui-se que o programa de exercícios utilizado em pacientes que apresentam DC na CV é positivo na melhora do prognóstico e qualidade de vida; redução de incapacidades e crenças. Ainda, exercícios domiciliares incentivam o protagonismo dos pacientes.

Low back pain prevalence, beliefs, and treatment seeking behaviour in multi-ethnic Suriname

Objectives To determine LBP prevalence in urban and rural communities and to assess back beliefs and treatment seeking behaviour for the first time in Suriname, a multi-ethnic country in the Caribbean community. Methods A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information on LBP prevalence and LBP-related treatment seeking, beliefs about LBP (Back Beliefs Questionnaire (BBQ)), level of disability (Oswestry Disability Index), and the risk of developing persistent disabling pain (Start Back Screening Tool) was collected. Results A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (&gt;55 years). Individuals from rural areas (median BBQ = 18.00 (14.00–22.00)) had significantly more negative beliefs than the urban population (median BBQ = 25.00 (19.00–31.00)) (p &lt; 0.001). Maroons displayed more negative beliefs than Creole (p = 0.040), Hindustani (p &lt; 0.001), Javanese (p &lt; 0.001) and Mixed ethnicity (p &lt; 0.001). At least 75% of the LBP population sought care, especially from a western healthcare practitioner. Seeking treatment and having a higher risk to develop persistent disabling pain was significantly associated with more disability (p &lt; 0.001). Age ≥45 years (p &lt; 0.001), Indigenous ethnicity (p &lt; 0.05), and functional disability (p &lt; 0.001) were factors influencing treatment seeking. Conclusions LBP is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western healthcare practitioner and had more negative beliefs compared with other communities.

Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain

Background: The STarT Back Screening Tool (SBST) is a self-report questionnaire developed for prognostic purposes which evaluates risk factors for disability outcomes in patients with chronic low back pain. Previous studies found that its use enables to provide a cost-effective stratified care. However, its dimensionality has been assessed only using exploratory approaches, and reports on its psychometric properties are conflicting.Objective: The objective of this study was to assess the factorial structure and the psychometric properties of the Italian version of the STarT Back Screening Tool (SBST).Materials and Methods: Patients with medical diagnosis of low back pain were enrolled from a rehabilitation unit of a tertiary care hospital specialized in obesity care (Sample 1) and from a clinical internship center of an osteopathic training institute (Sample 2). At baseline and after 7 days patients were asked to fill a battery of self-report questionnaires. The factorial structure, internal consistency, test-retest reliability, and construct validity of the SBST were assessed.Results: One hundred forty-six patients were enrolled (62 from Sample 1 and 84 from Sample 2). The confirmatory factor analysis showed that the fit of the original two-correlated factors model was adequate (CFI = 0.98, TLI = 0.99, RMSEA = 0.03). Cronbach's α of the total scale (α = 0.64) and of the subscales (physical subscale α = 0.55; psychological subscale α = 0.61) was below the cutoffs, partly because of the low correlation of item 2 with the other items. Test-retest reliability was adequate (ICC = 0.84). The SBST had moderate correlations with comparisons questionnaires, except for the Roland-Morris Disability Questionnaire, which had a high correlation (r = 0.65).Discussion: The SBST has adequate psychometric properties and can be used to assess prognostic factors for disability in low back pain patients.

Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain

Background Low back pain (LBP) is a top musculoskeletal problem and a substantial cause of socioeconomic burden internationally. The STarT Back Screening Tool (SBST) is a useful screening tool to manage patients with LBP but it is unavailable in Thai. Therefore, the aims of this study were to translate and cross-culturally adapt the SBST into a Thai version (SBST-TH) and validate its psychometric properties (e.g., factor analysis, internal consistency, test-retest reliability, agreement, convergent validity and discriminative validity). Methods Translation and cross-cultural adaptation of the SBST into Thai version were conducted according to standard guidelines. A total of 200 participants with non-specific LBP were invited to complete the SBST, visual analogue scale for pain intensity, Roland-Morris disability questionnaire (RMDQ), fear-avoidance beliefs questionnaire, pain catastrophising scale, hospital anxiety and depression scale and the EuroQol five-dimensional questionnaire. Thirty participants completed the SBST-TH twice with an interval of 48 h to evaluate test-retest reliability. Results Factor analysis demonstrated two (physical and psychological) components for the SBST-TH (39.38% of the total variance). The Cronbach’s alpha (0.86 for total score and 0.76 for psychosocial subscore) represent satisfactory internal consistency. The acceptability of intraclass correlation coefficient was found in the total (0.73) and subscore (0.79). The areas under the curve (AUC) for the total score ranged 0.67–0.85 and 0.66–0.75 for subscore. The excellent discriminative validity was observed (AUC = 0.85, 95% confidence interval = 0.72, 0.97) between the total score of the SBST-TH and disability (RMDQ). Spearman’s correlation coefficients represented moderate to strong correlation (0.32–0.56) between the SBST-TH and all questionnaires. The findings suggest a good relationship between the SBST-TH and disability and quality of life. Owing to the results from the convergent and discriminative validity, construct validity of the SBST-TH can be supported. The minimal detectable changes of the total score and subscore were 2.04 and 1.60, respectively. Significant floor and ceiling effects were not found in the SBST-TH. Conclusion The SBST-TH was successfully translated and adapted. It is a valid and reliable tool to classify Thai patients with non-specific LBP into low, moderate and high risks for chronicity. Trial registration TCTR20191009005#.

Avaliação do método Pilates no tratamento de indivíduos com dor lombar crônica inespecífica: ensaio clínico randomizado

Introdução: A dor lombar crônica inespecífica (DLCI) é uma sintomatologia dolorosa comum na região inferior da coluna por período superior a doze semanas, podendo ser acompanhada de sintomas neurológicos em membros inferiores. A DLCI apresenta alta prevalência mundial, pode conduzir a limitações de função e o tratamento enfatiza terapias ativas, tais como exercícios de Pilates. Objetivo: Avaliar o efeito de exercícios de Pilates na percepção dolorosa, qualidade de vida, incapacidade funcional e cinesiofobia de indivíduos com DLCI, classificados com baixo e médio riscos de mau prognóstico conforme a versão brasileira do Start Back Screening Tool (SBST-Brasil). Métodos: Ensaio clínico randomizado controlado com 59 pacientes diagnosticados clinicamente com DLCI, divididos em dois grupos: Controle (GC) e Pilates (GP). Durante 12 semanas, o GC recebeu intervenção medicamentosa enquanto o GP foi submetido a um protocolo de exercícios do método Pilates duas vezes na semana. Resultados: O treinamento com Pilates reduziu dor e cinesiofobia em ambos os subgrupos com SBST-Brasil Baixo e Médio. Contrariamente aos participantes de médio risco de mau prognóstico do GC, o GP com médio risco apresentou melhora significativa (P<0,05) da capacidade funcional. A intervenção farmacológica se mostrou eficiente (P<0,05) na redução da catastrofização da dor e cinesiofobia no GC classificados com médio risco de mau prognóstico. Conclusão: A estratificação em baixo e médio riscos para mau prognóstico de incapacidade têm respostas positivas ao tratamento baseado em exercícios do método Pilates, considerando a redução da intensidade dolorosa e da limitação funcional.

Translation, cross-cultural adaptation and validation of English start back screening tool into Bangla for patients with low back pain

This study was intended to translate and culturally adapt the STarT back screening tool to produce an equivalent Bangla version. Total 58 patients with low back pain completed the newly developed Bangla version of STarT back screening tool and Bangla version of Ronald Morris Disability Questionnaire seven days apart. Reliability was assessed by internal consistency (Chronbach’s alpha for overall score 0.81 and for spychosocial subscale was 0.76) and test-retest reliability (intraclass correlation coefficient for overall score was 0.78 and for spychosocial subscale was 0.71). Reliability of Bangla version of STarT back screening tool was very good. Pearson’s correlation coefficient was carried out on the Bangla version of STarT back screening tool and Bangla version of RMDQ to assess construct validity (overall score was 0.88 and spychosocial subscale score was 0.83) which indicate a strong correlation between them. This study shows that the Bangla version of STarT back screening tool is a reliable, valid and culturally adapted responsive screening tool for the patients with low back pain.