STarT back tool retained its predicting abilities in patients with acute and sub-acute low back pain after a transcultural adaptation and validation to Hebrew

Abstract

BackgroundThe STarT Back Screening Tool (SBT) distributes low back pain (LBP) patients into three prognostic groups for stratified care. This approach has demonstrated beneficial clinical and cost-effectiveness. ObjectivesTo translate and validate the SBT by investigating its psychometric properties among Israelis with acute and sub-acute LBP, and to evaluate its ability to predict disability after three months. DesignProspective study. MethodThe SBT was transcultural adapted into Hebrew using published guidelines. A total of 150 patients receiving physical therapy for acute or subacute LBP were administered the SBT. Clinical outcomes included the Roland-Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS), collected by an independent interviewer by phone at the start of the physical therapy treatment and after three months. ResultsThe test-retest reliability of the SBT total score and psychosocial subscale were excellent (intraclass correlation coefficient 0.89 and 0.82). Spearman's correlation coefficient between SBT total score and RMDQ was 0.82, HADS (Anxiety 0.66, Depression 0.76), FABQ (exercise 0.53), NPRS (severe pain 0.48, average pain 0.53). The SBT baseline score showed excellent predictive abilities in discriminating poor disability after three months (ROC curve = 0.825, P < 0.001, 95% CI 0.756–0.894). ConclusionThe Israeli translation and cross-cultural adaptation of the SBT is a valid and reliable instrument. The SBT discriminated low, medium and high-risk groups, and predicts disability after three months.