Validity and reliability of the Dutch STarT MSK tool in patients with musculoskeletal pain in primary care physiotherapy.

Anke G Van Den Broek,Martijn F Pisters,Cindy Veenhof,Corelien J J Kloek,Chris Connaboy

doi:10.1371/journal.pone.0248616

Abstract

ObjectiveTo evaluate the validity and reliability of the Dutch STarT MSK tool in patients with musculoskeletal pain in primary care physiotherapy.MethodsPhysiotherapists included patients with musculoskeletal pain, aged 18 years or older. Patients completed a questionnaire at baseline and follow-up at 5 days and 3 months, respectively. Construct validity was assessed by comparing scores of STarT MSK items with reference questionnaires. Pearson’s correlation coefficients were calculated to test predefined hypotheses. Test-retest reliability was evaluated by calculating quadratic-weighted kappa coefficients for overall STarT MSK tool scores (range 0–12) and prognostic subgroups (low, medium and high risk). Predictive validity was assessed by calculating relative risk ratios for moderate risk and high risk, both compared with low risk, in their ability to predict persisting disability at 3 months.ResultsIn total, 142 patients were included in the analysis. At baseline, 74 patients (52.1%) were categorised as low risk, 64 (45.1%) as medium risk and 4 (2.8%) as high risk. For construct validity, nine of the eleven predefined hypotheses were confirmed. For test-retest reliability, kappa coefficients for the overall tool scores and prognostic subgroups were 0.71 and 0.65, respectively. For predictive validity, relative risk ratios for persisting disability were 2.19 (95% CI: 1.10–4.38) for the medium-risk group and 7.30 (95% CI: 4.11–12.98) for the high-risk group.ConclusionThe Dutch STarT MSK tool showed a sufficient to good validity and reliability in patients with musculoskeletal pain in primary care physiotherapy. The sample size for high-risk patients was small (n = 4), which may limit the generalisability of findings for this group. An external validation study with a larger sample of high-risk patients (≥50) is recommended.

Highlights

Musculoskeletal conditions, such as low-back pain, neck pain, osteoarthritis and rheumatoid arthritis, are the most common cause of long-term pain and impaired physical function [1], and have large impact on health-related quality of life [2]
Relative risk ratios for persisting disability were 2.19 for the medium-risk group and 7.30 for the highrisk group
The risk ratios (RRs) for persisting disability were 2.19 for the medium-risk group and 7.30 for the high-risk group, both compared to the low-risk group

Summary

Introduction

Musculoskeletal conditions, such as low-back pain, neck pain, osteoarthritis and rheumatoid arthritis, are the most common cause of long-term pain and impaired physical function [1], and have large impact on health-related quality of life [2]. With the high impact of chronic musculoskeletal conditions on health care and work-related costs [4,5,6,7,8], there is a need for effective and cost-effective treatment options to manage musculoskeletal pain. In order to improve effectiveness on clinical outcomes and cost-effectiveness in the treatment of patients with musculoskeletal pain, a stratified care approach is promising [12]. Treatments are matched to patients based on key characteristics such as biomedical and psychosocial risk factors for poor prognosis. To identify modifiable risk factors for poor prognosis at an early stage and, subsequently, to stimulate that the appropriate stratified care will be applied to patients, a valid and reliable risk stratification tool is required

Methods

Results

Conclusion