The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire

Abstract

BackgroundMusculoskeletal pain and low back pain (LBP) in particular is one of the more costly health challenges to society. The STarT Back Tool (SBT) has been developed in the UK with a view to identifying subgroups of LBP patients in order to guide more cost effective care decisions. The Bournemouth Questionnaire (BQ) is a validated multidimensional patient reported outcome measure (PROM) that is widely used in routine clinical practice settings. This study sets out to describe and compare SBT and BQ scores within and between populations of patients presenting for chiropractic care in Norway and Great Britain.MethodsPatient demographics, BQ and the 5-item generic condition SBT data were collected from patients presenting with musculoskeletal pain to 18 Norwegian and 12 English chiropractors. Analysis of correlation between groups was achieved using a 1-way Chi2 approximation (p < 0.05).ResultsEleven percent of Norwegian LBP patients (n = 214) and 24% of English LBP patients (n = 186) were “distressed by their condition” (SBT > 4). By comparison, Norwegian chiropractic patients are: somewhat younger, have lower BQ scores, are less distressed by the condition and score significantly lower on items relating to catastrophisation and depression than English patients. There was an apparent association between total BQ and SBT scores (correlation 0.59, p < .0001) and patients who scored higher than 45 (IQR 39–58) on BQ were more likely to respond “distressed by condition” (>4) on SBT. Furthermore, patients in “distressed by condition” SBT category who had marked the “low mood” question on SBT also had a high score on the “depression” question of BQ (>6 (IQR 4–8), correlation 0.54, p < .0001).ConclusionThe BQ and SBT appear to identify the same subgroups in some, but not all of the measured items. It appears that unknown factors result in variations between patients seeking chiropractic care for comparable complaints in primary care in England vs Norway. Comparison of populations from Norway and UK demonstrate that extrapolating and pooling of data in relation to different populations should be done with caution, in regard to these stratification tools.

Low Back Pain in Primary Care: A Description of 1250 Patients with Low Back Pain in Danish General and Chiropractic Practice

“…There could be several reasons for the found differences between the populations, and they may vary between countries [ 23 ] although similar differences have also been demonstrated in the USA [ 24 ]. Since consultations in general practices are free of charge in Denmark, economic considerations are likely to influence choice of care provider, which could partly explain the higher education and the predominance of males among the chiropractic patients, which is in line with previous surveys [ 5 , 22 ].…”

The STarT back tool in chiropractic practice: a narrative review

“…Relationship between STarT Back Screening Tool and prognosis for low back pain patients receiving spinal manipulative therapyCompare outcomes for participants in the low, medium, and high risk SBT group after a course of usual chiropractic care.Prospective cohort n  = 4046 chiropractic clinics in EnglandLow: 42%Medium: 32%High: 27%Over half (56.2%) of the sample had pain for <1 month at the onset of care.-Primary outcome: PGIC g -Secondary outcomes: BQ pain subcategory and total BQ score-BQ pain and total score was strongly associated with SBT high risk group at baseline, but by the 30 day follow-up, there was no difference between SBT groups for these 2 outcomes.-SBT groupings were not statistically significantly associated with PGIC scores at any follow-up point.-When stratified by gender, males in the SBT high risk group had 3 times the odds of poor outcome compared to low risk males at 90 days.-SBT high risk group not statistically significantly associated with low pain improvement (defined as </=2 2 points on BQ pain scale). The high risk group improved just as much as the other risk groups at each follow up.-Duration of current pain episode and reoccurrence of the pain/problem for >30 days in the last year provided some prognostic ability, but variance and predictive accuracy was low. -Patients received usual care; it is unknown whether the chiropractors were tailoring treatment for high risk patients, according to their clinical expertise.−36.5% of the sample was lost to follow-up by the 90 day endpoint.Irgens et al 2013 [19]. The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth QuestionnaireExamine the correlation between the SBT and BQ f scores for low back pain patients presenting for chiropractic care in Norway and England.Cross-sectional n  = 21418 chiropractic clinics in Norway n  = 18612 chiropractic clinics in EnglandEpisode duration for both UK and Norwegian populations:<3 weeks: 45%>12 weeks: 37%Norwegian patients were younger, less distressed by their condition, and had lower catastrophization and depression rates, but higher anxiety rates than their English counterparts.-Positive association between BQ total score and SBT score for all areas of musculoskeletal complaint.-Each BQ question was positively associated with overall SBT score.-Strong association between the SBT depression sub-score and BQ low mood sub-score for neck pain, moderate for back pain, and low for extremity pain.-Strong association between the BQ pain sub-score and the SBT bothersomeness sub-score for back pain in Norwegian participants (this association was moderate for UK participants).-Moderate association between the BQ pain and SBT bothersomeness sub-score for neck pain in both countries.-The association between BQ and SBT anxiety sub-scores was low to moderate.-A validated Norwegian version of the SBT was not available at the time of the study.Newell et al 2015 [20].…”

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

“…Studies report the prevalence of SBT risk subgroups among patients seeking chiropractic care outside of the US [31–35], but similar analyses in US chiropractic patient populations have not been reported. In previous studies, the SBT was shown to be feasibly incorporated into Danish private practice chiropractic clinics [32] and exhibited construct validity in the European populations studied [31, 36]. One study indicated that SBT scores are less predictive among persons with an episode duration under 2 weeks, a characteristic more common among patients seeking chiropractic versus medical care [35].…”