Stratifying workers on sick leave due to musculoskeletal pain: translation, cross-cultural adaptation and construct validity of the Norwegian Keele STarT MSK tool

Abstract

Objectives Stratified care using prognostic models to estimate the risk profiles of patients has been increasing. A refined version of the popular STarT Back tool, the Keele STarT MSK tool, is a newly developed model for matched treatment across a wide range of musculoskeletal pain presentations. The aim of this study was to translate and culturally adapt the Keele STarT MSK tool into Norwegian, examine its construct validity and assess the representativeness of the included sample. Methods The Keele STarT MSK tool was formally translated into Norwegian following a multistep approach of forward and backward translation. A pre-final version was tested in 42 patients. Minor changes were implemented. To assess its construct validity, an online survey was conducted among workers aged 18–67 years who were on sick leave (>4 weeks) due to musculoskeletal disorders. Construct validity was evaluated in terms of convergent and discriminant validity using Pearson’s correlation coefficient, and known-group validity by comparing risk subgroups as suggested by the COSMIN checklist. The representativeness of the sample was assessed by comparing demographic and sick leave information of participants to eligible non-participants (n=168,137). Results A representative sample of 549 workers participated in the validity assessment; 74 participants (13.5%) were categorised as low risk, 314 (57.2%) as medium risk and 161 (29.3%) as high risk. The construct validity was found sufficient, with 90.9% and 75.0% of the pre-defined hypotheses confirmed for convergent and discriminant validity, and known-group validity, respectively. Floor or ceiling effects were not found. Conclusions The Keele STarT MSK tool was successfully translated into Norwegian. The construct validity of the tool was acceptable in a representative cohort of workers on sick leave as a result of musculoskeletal pain. However, the analyses raised concerns as to whether one of the questions captures the construct it is intended to measure.

Validation of the German version of the STarT-MSK-Tool: A cohort study with patients from physiotherapy clinics

“…This approach has been supported by a recent umbrella review indicating that there are a number of common prognostic factors among patients with MSK-complaints including: worse baseline function, higher symptom/pain severity, worse mental well-being, more comorbidities, older age and higher body mass index [16]. Several translations of the STarT-MSK-Tool are available, but a German version did not exist and knowledge about its measurement properties is limited [17][18][19][20][21].…”

Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study

“…Furthermore, there was a low volume of missing data for the prognostic factor variables and no missing data on variables used to calculate the outcome scores. Finally, the risk of selection bias is assumed to be low, as previous research 62 broadly confirms representativeness of the study sample.…”

Identification and Characterisation of Trajectories of Sickness Absence Due to Musculoskeletal Pain: A 1-Year Population-based Study

“…We previously showed that the study sample is largely representative of the population of workers on sick leave due to MSDs in terms of the distribution of socio-demographic variables (age, gender, musculoskeletal diagnosis, occupational group, annual salary, and geographical location) [ 19 ].…”