Abstract
The STarT back screening tool (SBT) allocates low back pain (LBP) patients into three risk groups and is intended to assist clinicians in their decisions about choice of treatment. The tool consists of domains from larger questionnaires that previously have been shown to be predictive of non-recovery from LBP. This study was performed to describe the distribution of depression, fear avoidance and catastrophising in relation to the SBT risk groups. A total of 475 primary care patients were included from 19 chiropractic clinics. They completed the SBT, the Major Depression Inventory (MDI), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Coping Strategies Questionnaire. Associations between the continuous scores of the psychological questionnaires and the SBT were tested by means of linear regression, and the diagnostic performance of the SBT in relation to the other questionnaires was described in terms of sensitivity, specificity and likelihood ratios.In this cohort 59% were in the SBT low risk, 29% in the medium risk and 11% in high risk group. The SBT risk groups were positively associated with all of the psychological questionnaires. The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 - 6.3) for the MDI to 7.6 (95% CI 4.9 - 11.7) for the FABQ. The SBT questionnaire was feasible to use in chiropractic practice and risk groups were related to the presence of well-established psychological prognostic factors. If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.
Highlights
Low back pain (LBP) is common and most cases of LBP are handled either without any contact to the health care system or in primary care [1,2]
Variability in research methods and quality limits what can be concluded about useful predictors in LBP, it seems that self-reported information on symptoms and beliefs about LBP is as valuable from a prognostic angle as data
Study Population A total of 607 questionnaires were distributed to the chiropractic clinics, and 543 questionnaires were completed between the 23rd of November and the 15th of December 2009
Summary
Low back pain (LBP) is common and most cases of LBP are handled either without any contact to the health care system or in primary care [1,2]. It is widely accepted that patients at risk of lasting back disability should be identified early in their course of LBP in order to prevent chronicity, and much effort has been put into investigating factors that predict non-recovery in LBP [4,5]. The STarT back screening tool (SBT) was introduced as a tool that can assist general practitioners’ decisionmaking concerning initial treatment options in primary care [6]. It consists of nine questions covering aspects of fear avoidance beliefs, depression, disability and presence of leg pain and neck/shoulder pain. Patients are allocated into one of three subgroups (low, medium or high risk of chronicity) based on the obtained score. The authors suggest that the low risk group only needs a ‘light’ intervention with e.g. analgesics and advice, the medium group requires treatments involving elements such as exercises or manual therapy, and that a combination of physical and cognitive-behavioral approaches should be considered for the high risk group [6]
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