Psychometric Properties of the Japanese Version of the STarT Back Tool in Patients with Low Back Pain

Abstract

Background and ObjectiveThe STarT Back Tool uses prognostic indicators to classify patients with low back pain into three risk groups to guide early secondary prevention in primary care. The present study aimed to evaluate the psychometric properties of the Japanese version of the tool (STarT-J).MethodsAn online survey was conducted among Japanese patients with low back pain aged 20–64 years. Reliability was assessed by examining the internal consistency of the overall and psychosocial subscales using Cronbach’s alpha coefficients. Spearman’s correlation coefficients were used to evaluate the concurrent validity between the STarT-J total score/psychosocial subscore and standard reference questionnaires. Discriminant validity was evaluated by calculating the area under the curves (AUCs) for the total and psychosocial subscale scores against standard reference cases. Known-groups validity was assessed by examining the relationship between low back pain-related disability and STarT-J scores.ResultsThe analysis included data for 2000 Japanese patients with low back pain; the mean (standard deviation [SD]) age was 47.7 (9.3) years, and 54.1% were male. The mean (SD) STarT-J score was 2.2 (2.1). The Cronbach’s alpha coefficient was 0.75 for the overall scale and 0.66 for the psychosocial subscale. Spearman’s correlation coefficients ranged from 0.30 to 0.59, demonstrating moderate to strong concurrent validity. The AUCs for the total score ranged from 0.65 to 0.83, mostly demonstrating acceptable discriminative ability. For known-groups validity, participants with more somatic symptoms had higher total scores. Those in higher STarT-J risk groups had experienced more low back pain-related absences.ConclusionsThe overall STarT-J scale was internally consistent and had acceptable concurrent, discriminant, and known-groups validity. The STarT-J can be used with Japanese patients with low back pain.

Estimated risk for chronic pain determined using the generic STarT Back 5-item screening tool

“…The Cronbach’s alpha coefficient for the STarT-G was 0.71, indicating a good internal consistency. This value was similar to that obtained for the Japanese 9-item STarT scale (0.75) 13. Concurrent validity was assessed by analyzing correlations between the STarT-G and pain NRS scores, which were moderately correlated with each other ( r = 0.34).…”

Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain

“…The results of the present study suggest the use of screening questionnaires to compensate for the low sensitivity of PT identification of psychological problems among patients. Some screening questionnaires for LBP prognosis have been proposed [28,29]. However, no study has shown the Japanese cutoff points for screening questionnaires that have high sensitivity to detect psychological problems.…”

Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care

“…has generated great interest in developed countries, providing new hope that meaningful improvements in primary care for LBP are within reach. [14][15][16][17][18][19] Prior to widespread implementation, it would be valuable to know if the STarT Back strategy can be successfully translated to other settings. To determine if the STarT Back risk stratification strategy would succeed in the USA, we conducted the Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) cluster randomized trial.…”