Abstract
BackgroundStratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. A comprehensively studied stratification instrument is the STarT Back Tool (SBT). It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). Moreover, the potential to improve prognosis for disability by adding further predictor variables, an analysis for differences in pain intensity according to the STarT-Classification, and discriminative ability were investigated.MethodsData from the control group of a randomized controlled trial were analysed. Trial participants were members of a private medical insurance with a minimum age of 18 and indicated as having persistent back pain. Measurements were made for the risk of back pain chronification using the STarT-G, disability (as primary outcome) and back pain intensity with the Chronic Pain Grade Scale (CPGS), health-related quality of life with the SF-12, psychological distress with the Patient Health Questionnaire-4 (PHQ-4) and physical activity. Analysis of variance (ANOVA), multiple linear regression, and area under the curve (AUC) analysis were conducted.ResultsThe mean age of the 294 participants was 53.5 (SD 8.7) years, and 38% were female. The ANOVA for disability and pain showed significant differences (p < 0.01) among the risk groups at 12 months. Post hoc Tukey tests revealed significant differences among all three risk groups for every comparison for both outcomes. AUC for STarT-G’s ability to discriminate reference standard ‘cases’ for chronic pain status at 12 months was 0.79. A prognostic model including the STarT-Classification, the variables global health, and disability at baseline explained 45% of the variance in disability at 12 months.ConclusionsDisability differences in patients with back pain after a period of 12 months are in accordance with the subgroups determined using the STarT-G at baseline. Results should be confirmed in a study developed with the primary aim to investigate those differences.
Highlights
Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines
The analysed data included in this study came from those allocated to the control group, and those people were invited to participate in a survey dealing with persistent back pain while receiving usual care
Our work focused on disability being one of the core domains for patients with back pain [36], and pain intensity was chosen as a secondary outcome
Summary
Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). For the purpose of prediction, several risk factors were identified and differentiated as being modifiable (e.g. psychological factors) or non-modifiable (e.g. pain history) [5,6,7] Despite this knowledge, and planning of treatment on such a basis seems ineffective, prediction in clinical practice mainly relies on experience and clinical judgement [1, 8]. To establish the prognosis of an unfavourable treatment outcome for patients with back pain, biomedical and modifiable psychosocial factors are determined using the STarT Back Tool (SBT) [6]. For groups at higher risk more severe disability is expected over time [6]
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