Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care

Abstract

ObjectivesThe predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT’s predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain.SettingProspective data from 35 primary care centres in south Sweden during 2013.ParticipantsPatients (n=329) with acute/subacute back and/or neck pain, aged 18–67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11–27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%).OutcomesThe predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC).ResultsBased on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability.ConclusionsThe SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice.Trial registration number NCT02609750; Results.

Effectiveness of stratified treatment for back pain in Danish primary care: A randomized controlled trial

“…This indicates that most participants remained at work despite LBP. This is in line with earlier studies (Chen et al., 2018 ; Forsbrand et al., 2018 ; Grovle et al., 2013 ). It could be argued that RTW might not be the right outcome measure for intervention studies where participants are working to some extent and that short‐term sick leave, for example, measured in days is more likely to detect change or between group differences, than measured in weeks.…”

Associations between multisite pain, depressive symptoms and disturbed sleep with work ability and health-related quality of life in female health care workers with recurrent non-specific low back pain: a cross-sectional study

“…Furthermore, poor work ability combined with chronic disease is also associated with high risk for long-term sickness absence (29). Patients with LBP are also at risk for poor health-related quality of life (HRQoL) (39). In this study, those participants with poor FWA also had lower HRQoL.…”

Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study

“…SBST and work ability has also been associated with quality of life and daily life outcome in previous studies. 36 37 Patients' expectations of future work ability at 2 years, obtained at baseline, was associated with daily life outcome after 6 months in a German study of patients attending physiotherapy. 36 Also in line with our results, a Swedish group found that SBST could predict quality of life as well as work ability in patients with acute or subacute back or neck pain.…”

“…36 Also in line with our results, a Swedish group found that SBST could predict quality of life as well as work ability in patients with acute or subacute back or neck pain. 37 Our point of departure was that if screening tools integrate patients' perspective on the work dimension, it could facilitate and inform the integration of the work domain in management. The screening item from Örebro musculoskeletal pain questionnaire focused on patients' own expectations on future work ability.…”

“… 36 Also in line with our results, a Swedish group found that SBST could predict quality of life as well as work ability in patients with acute or subacute back or neck pain. 37 …”