Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey

Abstract

BackgroundThe Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care.MethodsThe SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores).ResultsOf 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]).ConclusionThe sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.

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

“…The predictive ability in this study was slightly lower compared to an earlier study in Danish primary care (Morso et al., 2013 ) and it could potentially affect the results, but still, the SBT subgroup classification was predictive of prolonged disability. A recent study shows that stratification at 6 weeks is an optimal time point (Medeiros et al., 2018 ); this is in line with earlier studies by Khan et al (Khan et al., 2019 ) and Morso et al (Morso et al., 2016 ). LBP duration might have affected the SBT predictive ability, perhaps risking subgroup misclassification.…”

Suicide prevention, public health, and the chiropractic profession: a call to action

“…In the contemporary practice of chiropractic, consideration of the biomedical, psychological, and social factors associated with spinal pain is necessary to complete the clinical picture and understanding to develop a care plan for each patient’s needs and make referrals when necessary [ 14 – 16 ]. Dr. Richard Brown, the World Federation of Chiropractic (WFC) Secretary-General, has called for chiropractors to become EPIC: e vidence-based , p atient-centered , i nterprofessional , and c ollaborative [ 17 ].…”