Reliability and screening ability of the StarT Back screening tool in patients with low back pain in physiotherapy practice, a cohort study

Abstract

BackgroundLow back pain (LBP) is the most common reported musculoskeletal disorder, with large prevalence numbers and high costs. Focus on early identification of patients at risk of developing chronic LBP has increased. The Keele Start Back Tool (SBT) is a questionnaire aiming at screening prognostic indicators in LBP patients, categorizing patients into risk-groups and guide treatment. The aim of this study was to explore the Norwegian version of the SBT with regard to reliability of the SBT-scoring and the screening ability in LBP patients in primary care physiotherapy.MethodsLBP patients answered a package of questionnaires twice, with 1-3 days in between, containing SBT, Hannover functional ability questionnaire, pain intensity questions and demographics. The relative and absolute reliability of SBT was calculated using intraclass correlation coefficient (ICC) and the smallest detectable change respectively. Independent sample t-tests were used for group comparisons.ResultsFifty-two patients with LBP. Mean age (SD) was 45 (12) years and 62% were female. The ICC (95% CI) for SBT total score and psychosocial subscore was 0.89 (0.82, 0.94) and 0.82 (0.70, 0.90) respectively. None of the participants were allocated to the high risk group. The medium risk group reported significantly more pain last week and more activity limitations than the low risk group at both test and retest (0.001 ≤ p ≤ 0.003), whereas no significant difference between the groups was found on pain now (0.05 ≤ p ≤ 0.16).ConclusionsThe Norwegian version of the SBT was reliable and the screening ability was good as the subgrouping of patients into risk-groups reflected the severity of their back problems. The SBT may be an applicable and useful tool in physiotherapy practice.

Efficacy of Pulsed Low-Frequency Magnetic Field Therapy on Patients with Chronic Low Back Pain: A Randomized Double-Blind Placebo-Controlled Trial

“…CLBP patients should be screened for prognostic indicators by identifying modifiable risk factors (biomedical, psychological, and social) before initial decision-making. The current study findings support the notion that patients should be categorized into low, medium, and high-risk categories, and then treatment options should be customized [30].…”

Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews

“…Reliability and validity are summarised in Supplementary Table 3. Nine studies assessed the internal consistency of the tool, with a Cronbach's α ranging from 0.51 to 0.93 (poor to strong) 68,75,82,88,98,99,101,103,109 . Only one study achieved an internal consistency above 0.9 (strong), which is recommended for use in individuals 101 .…”

“…Only one study achieved an internal consistency above 0.9 (strong), which is recommended for use in individuals 101 . Nine studies also assessed the test−retest reliability of the STarT Back with the intraclass correlation coefficient and kappa values ranging from 0.65 to 0.93 (moderate to excellent) 74,75,82,87,98,99,101,103,109 . Construct validity was assessed in ten studies with correlation values ranging from 0.18 to 0.75 (weak to strong); however, most comparisons were of moderate strength 68,71,74,75,79,82,87,98,103,109 .…”

Accelerometer-based facilitated walking program in addition to usual care for the management of patients with low back pain at medium or high risk of chronicity: a randomised controlled trial protocol

“…People categorised as having medium or high risk of chronicity are more disabled with their pain and more likely to have a poor outcome than those having low risk. 12 Since people at low risk have a good prognosis and highest probability of recovering spontaneously, a minimal intervention (i.e. education and self-management) is highly recommended.…”