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Vengatraman S, Aseer Peter AL, Kannan S. Cross-cultural adaptation, reliability, validity, and psychometric evaluation of the Tamil version STarT back screening tool among low back pain subjects. J Orthop Sci 2024; 29:952-957. [PMID: 37482443 DOI: 10.1016/j.jos.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/20/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The STarT back screening tool helps primary care workers make the initial clinical decision and classify low back pain subjects into subgroups. Currently, the tool is required for stratification/triaging of low back pain and is commonly used in clinical practice, and requires linguistic validation in Tamil. The study aimed to determine the validity and reliability of the Tamil version of the STarT back screening tool. METHODS The baseline measurements include the Tamil version of the STarT back screening tool-, pain severity using the Numeric pain rating Scale (NPRS), disability status using the Tamil version of the Roland Morris Disability Questionnaire (RMDQ), and fear avoidance beliefs using the fear-avoidance beliefs questionnaire (FABQ) - Tamil were obtained. After five days, the retest measures are done to investigate the test-retest reliability. RESULTS The current study showed excellent test-retest reliability of total score (ICC - 0.80) and psychosocial subscore (ICC-0.82) with excellent internal consistency and moderate to high validity with clinical outcomes. CONCLUSION The study concludes that the Tamil version of the STarT Back Screening Questionnaire is a reliable and valid tool that reported good understanding and easy completion by the subject.
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Affiliation(s)
- Srinithi Vengatraman
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India
| | - Antony Leo Aseer Peter
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India.
| | - Soundararajan Kannan
- Sri Ramachandra Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Porur, Chennai, India
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Cimerman M, Kacin A. Reproducibility and content validity of the Slovenian version of the STarT Back Screening Tool for chronicity risk assessment in patients with low back pain. Int J Rehabil Res 2023; 46:350-354. [PMID: 37906074 DOI: 10.1097/mrr.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Chronic pain is the most common cause of impaired work ability and thus represents a significant social and economic burden. STarT Back Screening Tool (SBT) is the most often used screening tool for rapid identification and classification of patients for their risk of development of chronic low back pain, which is valid and reliable in the original English version and translation into other languages. The aim of the present study was to translate the SBT into Slovenian and to evaluate its content validity and reliability. We translated the SBT from English into Slovenian and back according to the standard protocol. We tested its metric properties on a group of patients with low back pain aged 18 to 65 years. The reliability of the reassessment was calculated using the ICC and specific agreement, while the content validity of the questionnaire was determined using the ceiling and floor effect. Of the 42 patients who participated in the study, 42.9% were at low risk, 33.3% were at moderate risk, and 23.8% were at high risk of developing chronic pain, according to the SBT. The ICC for the entire sample was 0.96 (95% CI 0.92-0.98). The Slovenian translation of the SBT showed excellent specific agreement between the initial and repeat assessments: 91.4% for the low-risk group, 85.7% for the moderate-risk group, and 95.2% for the high-risk group. In addition, it showed good content validity, as no ceiling or floor effects were detected. The Slovenian translation of the questionnaire is suitable for clinical use.
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Affiliation(s)
- Marinka Cimerman
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
| | - Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Robarts S, Razmjou H, Yee A, Finkelstein J. Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools. Physiother Can 2023; 75:158-166. [PMID: 37736380 PMCID: PMC10510560 DOI: 10.3138/ptc-2021-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 09/23/2023]
Abstract
Purpose STarT Back Screening Tool and OSPRO-YF scales have been reported to be accurate tools for estimating risk for the development of persistent pain or prolonged disability in primary care settings. We performed a comparison of construct convergent and known-group validity and ceiling floor effect (CFE) of these tools using a common sample of patients seen at a tertiary care spine centre. Methods This was a cross-sectional study of patients with and without a work-related back injury. The Hospital Anxiety and Depression Scale (HADS) was used as the reference outcome measure for convergent validity. For known-group validity, we examined the ability of the scales to differentiate between different levels of compensation, presence of non-organic signs, and work status. The CFE values were calculated. Results Fifty consecutive injured workers were included along with 50 patients without an active compensation claim related to their low back pain. STarTBack and OSPRO-YF had moderate to high associations with the depression component of the HADS (0.69 to 0.77 respectively) with a statistically significant difference in favour of the OSPRO-YF. STarTBack's risk stratification categories were able to differentiate patients with a compensable injury, non-organic signs, and inability to work (p values ranging from 0.002 to < 0.001). The physical activity and work fear-avoidance beliefs constructs of the OSPRO-YF consistently outperformed other yellow flag constructs (p values ranging from 0.008 to < 0.001). The psychological sub-score of STarTBack showed a ceiling effect. There was a floor effect for the negative affect domain of OSPRO-YF. Neither total score had a floor or ceiling effect. Conclusions STarTBack and OSPRO-YF are short screening tools with acceptable convergent and known-group construct validity and no floor or ceiling effect of their total score. Both tools could assist with the identification, evaluation, and management of psychological distress in patients presenting to tertiary care spine centres.
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Affiliation(s)
- Susan Robarts
- From the:
Bone and Joint Program, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Razmjou
- From the:
Bone and Joint Program, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Finkelstein
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Lardon A, Pagé I, Nougarou F, Descarreaux M. Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial. J Manipulative Physiol Ther 2022; 45:1-8. [PMID: 35753884 DOI: 10.1016/j.jmpt.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/06/2021] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the immediate effect of spinal manipulation (SMa) and spinal mobilization (SMo) on muscular responses, spinal stiffness, and segmental spinal pressure evoked pain in a population of participants with chronic middle back pain (MBP). METHODS In a crossover randomized trial, 2 experienced chiropractors assessed whether volunteers were eligible for the protocol according to a list of specific inclusion and exclusion criteria. Individuals with MBP participated in 2 experimental sessions within 72 hours. During the first session, participants randomly received a SMa or SMo delivered by an apparatus using a servolinear motor. During the second session, the other modality was delivered. Spinal stiffness and pressure-provoked pain intensity outcomes were assessed before and after each therapy, and muscular responses were recorded during the treatment using surface electromyographic sensors. Signed-rank Wilcoxon tests for muscular responses and generalized model for repeated measure for spinal stiffness and pressure-provoked pain were used for statistical analyses. RESULTS Among the 32 potential participants, 26 (mean age 29.9 [±9.14], 15 women) completed both sessions. Between-group differences were observed for the muscular response amplitude (P < .001), and indeed the normalized RMS muscular response was found to be higher during SMa than SMo. Similar results were observed for pressure-provoked pain intensity at the level of therapeutic modality application (P = .002) as a higher decrease in pain was found after SMa (47.9 [±22.8] to 36.6 [±23.7]) compared with SMo (47.2 [±23.2] to 45.5 [±24.3]). No between-group differences were found for spinal stiffness change, nor for terminal (P = .08) and global spinal stiffness (P = .06). CONCLUSION In a controlled environment, spinal manipulation and mobilization generated different muscle responses and had different immediate effects on pressure-provoked pain intensity for subjects with MBP.
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Affiliation(s)
- Arnaud Lardon
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada; Franco-European Institute of Chiropractic, Ivry-sur Seine, France.
| | - Isabelle Pagé
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
| | - François Nougarou
- Department of Electrical Engineering, University of Québec, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
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Rysstad T, Grotle M, Aasdahl L, Hill JC, Dunn KM, Tingulstad A, Tveter AT. Stratifying workers on sick leave due to musculoskeletal pain: translation, cross-cultural adaptation and construct validity of the Norwegian Keele STarT MSK tool. Scand J Pain 2022; 22:325-335. [PMID: 35148473 DOI: 10.1515/sjpain-2021-0144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Tarjei Rysstad
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Research- and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Kate M Dunn
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Alexander Tingulstad
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Therese Tveter
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Marineau Belanger E, Boon DM, Descarreaux M, Abboud J. The effect of low back pain on neuromuscular control in cyclists. J Sports Sci 2022; 40:1255-1264. [PMID: 35389326 DOI: 10.1080/02640414.2022.2061819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study was designed to identify neuromuscular adaptations of low back pain (LBP) cyclists , and the impact of a cycling effort on spinal shrinkage. Forty-eight trained cyclists rode their road bike on a smart trainer for 1-hour. Surface electromyography (EMG) recorded muscle activity of the lumbar erector spinae (LES), 3D motion analysis system recorded kinematic of the trunk, and stadiometry measured spinal height. Statistical comparisons were made using repeated measure ANOVAs. The LBP group presented increase in pain levels throughout the effort (p < 0.001). A significant group difference was only observed for the thoracic angle (p = 0.03), which was less flexed for LBP. The one-hour cycling effort (time effect) significantly increased the trunk flexion (p < 0.001) and thoracic flexion (p < 0.001) for both groups. Significant lower LES activation (35% less) was observed at the end of the effort as well as a decrease in spinal height (p = 0.01) for both groups. Neuromuscular adaptations to cycling effort is identified by a decrease in LES EMG amplitude and an increase flexion of the trunk. Adaptation to pain is seen by an increase in thoracic flexion. Despite these adaptations, LBP cyclists could not ride their bike pain-free.
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Affiliation(s)
- Emile Marineau Belanger
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Dan-Mihai Boon
- parcours neuroscience du mouvement, Université de Paris-Est CréteilFaculté de biologie-santé.,Institut Franco-Européen de Chiropraxie, Campus Paris, France
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Jacques Abboud
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Naïr A, Lin CI, Wippert PM. Translation and Adaptation of the French Version of the Risk Stratification Index, a Tool for Stratified Care in Chronic Low Back Pain: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040469. [PMID: 35454308 PMCID: PMC9030194 DOI: 10.3390/medicina58040469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Low back pain is a worldwide health problem. An early diagnosis is required to develop personalized treatment strategies. The Risk Stratification Index (RSI) was developed to serve the purpose. The aim of this pilot study is to cross-culturally translate the RSI to a French version (RSI-F) and evaluate the test-retest reliability of RSI-F using a French active population. Materials and Methods: The RSI was translated from German to French (RSI-F) based on the guidelines of cross-cultural adaptation of self-report measures. A total of 42 French recreational athletes (age 18−63 years) with non-specific low back pain were recruited and filled in the RSI-F twice. The test-retest reliability was examined using intraclass correlation coefficient (ICC1,2) and Pearson correlation coefficient. Results: Finally, 33 questionnaires were analyzed (14 males and 19 females, age 31 ± 10 years, 9.5 ± 3.2 h/week of training). The test-retest of RSI-F CPI and DISS were excellent (CPI: ICC1,2 = 0.989, p < 0.001; r = 0.989, p < 0.001; DISS: ICC1,2 = 0.991, p < 0.001; r = 0.991, p < 0.001), as well as Korff pain intensity (ICC1,2 = 0.995, p < 0.001; r = 0.995, p < 0.001) and disability (ICC1,2 = 0.998, p < 0.001; r = 0.998, p < 0.001). Conclusion: The RSI-F is linguistically accurate and reliable for use by a French-speaking active population with non-specific low back pain. The RSI-F is considered a tool to examine the evolution of psychosocial factors and therefore the risk of chronicity and the prognostic of pain. Further evaluations, such as internal, external validity, and responsiveness should be evaluated in a larger population.
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Affiliation(s)
- Alexandra Naïr
- Medical Sociology and Psychobiology, Department of Physical Activity and Health, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany; (A.N.); (C.-I.L.)
| | - Chiao-I Lin
- Medical Sociology and Psychobiology, Department of Physical Activity and Health, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany; (A.N.); (C.-I.L.)
| | - Pia-Maria Wippert
- Medical Sociology and Psychobiology, Department of Physical Activity and Health, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany; (A.N.); (C.-I.L.)
- Faculty of Health Sciences Brandenburg (Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg University of Technology Cottbus–Senftenberg), University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
- Correspondence:
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Ebrahim H, Pillay-Jayaraman P, Leibovitz Y, Naidoo N, Bulmer T, Bull B, Lord S, Keller MM. Experiences and effects of telerehabilitation services for physiotherapy outpatients in a resource-constrained public health set-up in the backdrop of the COVID-19 pandemic: A proposal. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1528. [PMID: 34230898 PMCID: PMC8252170 DOI: 10.4102/sajp.v77i1.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background The announcement of a national lockdown in South Africa had country-wide impact on the delivery of health services. Strategies included prioritisation of patients and protecting patients who were considered at risk, resulting in the need for cancellation and temporary termination of many outpatient therapy services. This necessitated the urgent need to come up with a way of delivering physiotherapy rehabilitation services to patients in a more non-traditional format. Telerehabilitation allows for the provision of services by using electronic communication, thus ensuring that patients are still able to access necessary rehabilitation services. Methods/design This is a prospective, mixed method study with participants recruited from the outpatient physiotherapy department of Chris Hani Baragwanath Academic Hospital (CHBAH). Telerehabilitation services will be provided via the patients' preferred method of communication. On discharge, participants and therapists will be asked about their experiences of telerehabilitation. Discussion Because of the current coronavirus disease 2019 (COVID-19) pandemic, patients are unable to receive traditional face-to-face physiotherapy services. Telerehabilitation offers a suitable alternative to treatment, but the feasibility, outcome and experiences of offering these services in the public health system have not been studied. Conclusion This study will determine whether telerehabilitation is a feasible service that can be offered in the COVID-19 pandemic, as well as post-pandemic, to enable physiotherapists to access those patients who are often unable to attend physiotherapy because of transport costs and various other reasons for non-attendance. Clinical implications The results of this study may indicate a way of managing patients in situations where face to face therapy cannot be undertaken. Protocol identification Pan African Clinical Trial Registry, PACTR202103637993156.
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Affiliation(s)
- Humairaa Ebrahim
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Prithi Pillay-Jayaraman
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yehudit Leibovitz
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nirvashi Naidoo
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Tracey Bulmer
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Bulelwa Bull
- Department of Physiotherapy, Faculty of Health, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sandy Lord
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Monique M Keller
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Billis E, Fousekis K, Tsekoura M, Lampropoulou S, Matzaroglou C, Gliatis J, Sinopidis C, Hill J, Strimpakos N. Cross-cultural validation of the start back screening tool in a Greek low back pain sample. Musculoskelet Sci Pract 2021; 53:102352. [PMID: 33714780 DOI: 10.1016/j.msksp.2021.102352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Keele STarT Back Screening Tool (SBST) is a popular 9-item prognostic recovery questionnaire for low back pain (LBP) with validation studies in several cultural settings, but not Greek. OBJECTIVES The cross-cultural adaptation and validation of the SBST into Greek among LBP and LBP-associated leg pain patients. METHODS A five-stage forward-backward translation procedure developed the Greek SBST. LBP and sciatica patients completed SBST, Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Short-form Health Survey (SF-12), Sciatica Bothersomeness Index (SBI), numeric pain rating scale (NPRS) and body chart pain location sites. Measurement properties (internal consistency, content, construct and discriminatory validity) were explored. Test-retest reliability was explored by re-administering SBST after 7-10 days across patients whose symptoms remained unchanged. RESULTS 124 LBP patients (75 females, 49.1 ± 14.2 years-old) 43.5% of whom had sciatica completed Greek SBST. No floor/ceiling effects were detected. Mean score distributions were statistically different across SBST groups. Moderate to strong correlations were found for SBST (total and psychosocial scores) with RMDQ, SBI, HADS and SF-12 (Spearman's ρ = 0.42-0.60). Most associations between individual SBST items and reference standards were moderately correlated (ρ = 0.32-0.49). Greek SBST yielded acceptable discriminant validity with RMDQ (AUC of 0.80). Items 1, 3, 4, and 9 yielded acceptable discrimination against reference standards. Test-retest reliability was satisfactory for total score (ICC2,2 = 0.93) and individual items (kappa = 0.59-0.88). Cronbach's α was 0.70 (total score) and 0.76 (psychosocial subscale). CONCLUSIONS The Greek SBST was comprehensible, valid and reliable and may thus, be used across Greek cross-cultural rehabilitation research and practice.
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Affiliation(s)
- Evdokia Billis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
| | - Konstantinos Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Maria Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Sofia Lampropoulou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Charalampos Matzaroglou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - John Gliatis
- Orthopaedic Department, University Hospital of Patras, Greece
| | | | | | - Nikolaos Strimpakos
- Department of Physiotherapy, School of Health Sciences, University of Thessaly, Greece
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Wiangkham T, Phungwattanakul N, Thongbai N, Situy N, Polchaika T, Kongmee I, Thongnoi D, Chaisang R, Suwanmongkhon W. Translation, cross-cultural adaptation and psychometric validation of the Thai version of the STarT Back Screening Tool in patients with non-specific low back pain. BMC Musculoskelet Disord 2021; 22:454. [PMID: 34006259 PMCID: PMC8132393 DOI: 10.1186/s12891-021-04347-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/07/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a top musculoskeletal problem and a substantial cause of socioeconomic burden internationally. The STarT Back Screening Tool (SBST) is a useful screening tool to manage patients with LBP but it is unavailable in Thai. Therefore, the aims of this study were to translate and cross-culturally adapt the SBST into a Thai version (SBST-TH) and validate its psychometric properties (e.g., factor analysis, internal consistency, test-retest reliability, agreement, convergent validity and discriminative validity). METHODS Translation and cross-cultural adaptation of the SBST into Thai version were conducted according to standard guidelines. A total of 200 participants with non-specific LBP were invited to complete the SBST, visual analogue scale for pain intensity, Roland-Morris disability questionnaire (RMDQ), fear-avoidance beliefs questionnaire, pain catastrophising scale, hospital anxiety and depression scale and the EuroQol five-dimensional questionnaire. Thirty participants completed the SBST-TH twice with an interval of 48 h to evaluate test-retest reliability. RESULTS Factor analysis demonstrated two (physical and psychological) components for the SBST-TH (39.38% of the total variance). The Cronbach's alpha (0.86 for total score and 0.76 for psychosocial subscore) represent satisfactory internal consistency. The acceptability of intraclass correlation coefficient was found in the total (0.73) and subscore (0.79). The areas under the curve (AUC) for the total score ranged 0.67-0.85 and 0.66-0.75 for subscore. The excellent discriminative validity was observed (AUC = 0.85, 95% confidence interval = 0.72, 0.97) between the total score of the SBST-TH and disability (RMDQ). Spearman's correlation coefficients represented moderate to strong correlation (0.32-0.56) between the SBST-TH and all questionnaires. The findings suggest a good relationship between the SBST-TH and disability and quality of life. Owing to the results from the convergent and discriminative validity, construct validity of the SBST-TH can be supported. The minimal detectable changes of the total score and subscore were 2.04 and 1.60, respectively. Significant floor and ceiling effects were not found in the SBST-TH. CONCLUSION The SBST-TH was successfully translated and adapted. It is a valid and reliable tool to classify Thai patients with non-specific LBP into low, moderate and high risks for chronicity. TRIAL REGISTRATION TCTR20191009005 #.
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Affiliation(s)
- Taweewat Wiangkham
- grid.412029.c0000 0000 9211 2704Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand ,grid.412029.c0000 0000 9211 2704Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Nattawan Phungwattanakul
- grid.412029.c0000 0000 9211 2704Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Natthathida Thongbai
- grid.412029.c0000 0000 9211 2704Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Nisa Situy
- grid.412029.c0000 0000 9211 2704Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Titipa Polchaika
- grid.412029.c0000 0000 9211 2704Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Isara Kongmee
- grid.412029.c0000 0000 9211 2704Department of English Language, Faculty of Humanities, Naresuan University, Phitsanulok, 65000 Thailand
| | - Duangporn Thongnoi
- grid.412029.c0000 0000 9211 2704Department of English Language, Faculty of Humanities, Naresuan University, Phitsanulok, 65000 Thailand
| | - Rujirat Chaisang
- grid.412029.c0000 0000 9211 2704Department of English Language, Faculty of Humanities, Naresuan University, Phitsanulok, 65000 Thailand
| | - Wanisara Suwanmongkhon
- grid.7132.70000 0000 9039 7662Department of Accounting, Faculty of Business Administration, Chiang Mai University, Chiang Mai, 50200 Thailand
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11
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Szita J, Kiss L, Biczo A, Feher K, Varga PP, Lazary A. Outcome of group physical therapy treatment for non-specific low back pain patients can be predicted with the cross-culturally adapted and validated Hungarian version STarT back screening tool. Disabil Rehabil 2020; 44:1427-1435. [PMID: 32735178 DOI: 10.1080/09638288.2020.1799248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The STarT Back Tool was developed to identify the specific modifiable prognostic factors for non-specific low back pain and to classify the patients into risk groups; low, medium and high risk of chronicity. Applied therapeutic approaches often involve group physical therapy. The aim of this study was the cross-cultural adaptation and validation of the Hungarian version of the STarT Back Tool and to investigate the predictive ability for global treatment outcome. MATERIALS AND METHODS A prospective cohort study (N = 133) was carried out involving non-specific low back pain patients. Internal consistency, construct validity, reliability and prognostic discriminative ability have been investigated. After 3 months of treatment global outcome was evaluated. RESULTS A 2-factor structure was found, with moderate internal consistency (Cronbach α = 0.89 for the total and psychosocial subscale 0.62). Between the Hungarian STarT Back Tool, the Oswestry Disability Index, leg pain, low back pain, Tampa Scale for Kinesiophobia, Fear Avoidance Beliefs Questionnaire and the physical subscale of the quality of life questionnaire, significant good to excellent- correlation was found (r > 0.41). The test-retest analysis showed excellent reliability (Intraclass Correlation Coefficient = 0.93) with standard error measurement being 0.49 (minimal detectable change = 1.37). The Area Under the Curve for baseline STarT Back Tool scores was 0.7 and 0.8 for global treatment outcome and distress, respectively. The Area Under the Curve for global treatment outcome versus STarT risk groups proved to be 0.76 representing adequate discriminative ability. CONCLUSION The successful cross-cultural adaptation was followed by the validity analysis and as a result the Hungarian version of the STarT Back Tool proved to be a reliable and valid tool in the identification of risk groups of chronicity for patients with low back pain. Patients allocated to the high-risk group were more likely experiencing poor outcome at 3 months follow up, thus it can be used to predict outcome if treated with group physical therapy.Implication for rehabilitationLow back pain is a multifactorial disease where physical and psychosocial risk factors play a role in the development and prognosis of the disease.The STarT-H can be considered as a reliable, valid measurement tool in the identification of risk groups of chronicity for patients with low back pain.Clinical relevance of the STarT-H is that it can be used to stratify patients into risk groups of chronicity in different Hungarian speaking healthcare settings.According to our findings the STarT-H can also be applied to predict global treatment outcome in low back pain patients if treated with group physical therapy.
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Affiliation(s)
- Julia Szita
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Laszlo Kiss
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Adam Biczo
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary
| | - Katalin Feher
- Department of Spinal Surgery, National Center for Spinal Disorders, Budapest, Hungary
| | - Peter P Varga
- Department of Spinal Surgery, National Center for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.,Department of Spine Surgery, Semmelweis University, Budapest, Hungary
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12
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Tagliaferri SD, Angelova M, Zhao X, Owen PJ, Miller CT, Wilkin T, Belavy DL. Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews. NPJ Digit Med 2020; 3:93. [PMID: 32665978 PMCID: PMC7347608 DOI: 10.1038/s41746-020-0303-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022] Open
Abstract
Artificial intelligence and machine learning (AI/ML) could enhance the ability to detect patterns of clinical characteristics in low-back pain (LBP) and guide treatment. We conducted three systematic reviews to address the following aims: (a) review the status of AI/ML research in LBP, (b) compare its status to that of two established LBP classification systems (STarT Back, McKenzie). AI/ML in LBP is in its infancy: 45 of 48 studies assessed sample sizes <1000 people, 19 of 48 studies used ≤5 parameters in models, 13 of 48 studies applied multiple models and attained high accuracy, 25 of 48 studies assessed the binary classification of LBP versus no-LBP only. Beyond the 48 studies using AI/ML for LBP classification, no studies examined use of AI/ML in prognosis prediction of specific sub-groups, and AI/ML techniques are yet to be implemented in guiding LBP treatment. In contrast, the STarT Back tool has been assessed for internal consistency, test-retest reliability, validity, pain and disability prognosis, and influence on pain and disability treatment outcomes. McKenzie has been assessed for inter- and intra-tester reliability, prognosis, and impact on pain and disability outcomes relative to other treatments. For AI/ML methods to contribute to the refinement of LBP (sub-)classification and guide treatment allocation, large data sets containing known and exploratory clinical features should be examined. There is also a need to establish reliability, validity, and prognostic capacity of AI/ML techniques in LBP as well as its ability to inform treatment allocation for improved patient outcomes and/or reduced healthcare costs.
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Affiliation(s)
- Scott D. Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Maia Angelova
- School of Information Technology, Deakin University, Geelong, VIC Australia
| | - Xiaohui Zhao
- Xi’an University of Architecture & Technology, Beilin, Xi’an China
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Clint T. Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Tim Wilkin
- School of Information Technology, Deakin University, Geelong, VIC Australia
| | - Daniel L. Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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13
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Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B, Masse-Alarie H, Van Oosterwijck J, Belavy DL. Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective. Pain Pract 2019; 20:211-225. [PMID: 31610090 DOI: 10.1111/papr.12846] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Abstract
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.
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Affiliation(s)
- Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, U.S.A
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bernadette Fitzgibbon
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Hugo Masse-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Pain in Motion International Research Group
| | - Daniel L Belavy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Daneau C, Cantin V, Descarreaux M. Effect of Massage on Clinical and Physiological Variables During Muscle Fatigue Task in Participants With Chronic Low Back Pain: A Crossover Study. J Manipulative Physiol Ther 2019; 42:55-65. [PMID: 30955910 DOI: 10.1016/j.jmpt.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/08/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if a reduction of short-term physiological and clinical effects of muscle fatigue can be seen after a session of massage in nonspecific chronic low back pain (cLBP) individuals and to study the possible association between physiological and clinical changes induced by massage. METHODS Thirty-six cLBP individuals participated in 2 experimental sessions. In one session, the Sorenson protocol was preceded by a 30-minute massage, but in the other session, only the Sorenson test was performed by participants. Lumbar paraspinal muscle activity was recorded using surface electromyography, and maximal voluntary contraction force was measured using a load cell. Participants rated their lumbar pain intensity before and after massage and after the Sorensen protocol. A 2-way repeated-measures analysis of variance was conducted to test the effect of massage on both variables for both conditions. Pearson correlation analyses were conducted to determine the linear association between physiological and clinical responses to massage. RESULTS Results showed that pain perception was significantly reduced after massage (P = .004) but did not seem to influence pain score increases occurring after the Sorensen protocol. Individuals with a high score of low back pain-related disability showed lower back muscle endurance time (r = -.35). Massage yielded no significant effect on fatigue-related physiological variables. CONCLUSION The perception of pain in cLBP individuals was reduced after massage. Although massage yielded some positives clinical effects, they were not explained by a reduction in physiological effect of muscle fatigue.
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Affiliation(s)
- Catherine Daneau
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Vincent Cantin
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Mbada (PhD PT) CE, Afolabi (MSc PT) AD, Johnson (PhD PT) OE, Odole (PhD PT) AC, Afolabi (MSc PT) TO, Akinola (PhD PT) OT, Makindes (BMR PT) MO. Comparison of STarT Back Screening Tool and Simmonds Physical Performance Based Test Battery in Prediction of Disability Risks Among Patients with Chronic Low-Back Pain. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.
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16
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Elsabbagh L, Al-Atwi T, Aldossary D, Alshami AM, Hill JC, Abu-Ras W, Huijer HAS, Brooks D. Cross-cultural adaptation and validation of the STarT Back Tool for Arabic speaking adults with low back pain in Saudi Arabia. J Orthop Sci 2019; 24:200-206. [PMID: 30528225 DOI: 10.1016/j.jos.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The STarT Back Tool (Subgrouping for Targeted Treatment; SBT) was developed and validated in the United Kingdom for adults with non-specific low back pain (LBP) to provide risk stratification groups. An Arabic version has not yet been developed. Consequently, our objectives were: First, to cross-culturally adapt the SBT for use in Arabic speaking adults (SBT-Ar) with LBP. Second, to assess the face, content and construct validity of SBT-Ar against relevant reference standards. METHODS This was a prospective, cross-sectional study carried out in the outpatient department in a tertiary care hospital. A total of 59 participants (aged 18-60) with LBP able to read Arabic completed the questionnaire. SBT cross-cultural adaptation was performed according to published guidelines. Face and content validity were explored by individual interviews. Construct validity was assessed using pre-hypothesized correlations with relevant reference standards. RESULTS Following 48 individual interviews the SBT final version was reached and demonstrated face and content validity. The SBT-Ar total score and psychosocial sub-scale had acceptable internal consistency and no redundancy (Cronbach α = 0.7). Moderate Spearman's correlations were found between the SBT-Ar total score and reference standards (Arabic Pain Numeric Rating Scale NRS-Ar r = 0.50 and Arabic Oswestry Disability Index ODI-ar r = 0.51). As expected the SBT-Ar psychosocial subscale had medium to high correlations with the psychosocial reference measures (Arabic Fear-Avoidance Beliefs Questionnaire Physical Activity FABQPA-Ar r = 0.41, Arabic Hospital Anxiety and Depression Scale-Anxiety HADSA-Ar r = 0.58, Arabic Hospital Anxiety and Depression Scale-Depression HADSD-Ar r = 0.45 and Arabic Pain Catastrophizing Scale PCSAr r = 0.69).The SBT-Ar showed no significant floor or ceiling effects. CONCLUSION This study culturally adapted and preliminary validated SBT into Arabic. STUDY DESIGN Prospective, Cross-sectional.
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Affiliation(s)
- Lina Elsabbagh
- Physical Therapy Department, Faculty of Medicine, University of Toronto, Toronto, Canada; Physical Therapy Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia.
| | - Tasneem Al-Atwi
- Physical Therapy Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Dhai Aldossary
- Physical Therapy Department, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jonathan C Hill
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Wahiba Abu-Ras
- School of Social Work, Adelphi University, Garden City, NY, USA; Doha Institute for Graduate Studies, School of Psychology and Social Work, Al-Daayen, Qatar
| | | | - Dina Brooks
- Physical Therapy Department, Faculty of Medicine, University of Toronto, Toronto, Canada
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17
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Pagé I, Descarreaux M. Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial. BMC Musculoskelet Disord 2019; 20:29. [PMID: 30658622 PMCID: PMC6339327 DOI: 10.1186/s12891-019-2408-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week). METHODS Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control group. SMT were delivered through an apparatus using a servo-controlled linear actuator motor and doses consisted of peak forces, impulse durations, and rates of force application set at 135 N, 125 ms and 920 N/s (group 1), at 250 N, 125 ms and 1840 N/s (group 2), and at 250 N, 250 ms, 920 N/s (group 3). Disability and pain intensity were evaluated at each session (primary outcomes). Spinal stiffness was assessed before-and-after each SMT/rest and at follow-up. Tenderness and muscle activity were evaluated during each spinal stiffness trial. Improvement was evaluated at follow-up. Differences in outcomes between groups and sessions were evaluated as well as factors associated with clinical improvement. RESULTS Eighty-one participants were recruited and 17, 20, 20 participants of the three experimental groups and 18 of the control group completed the protocol. In exception of higher pain intensity at baseline in the control group, no between-group differences were found for any of the outcomes. A decrease in pain intensity, disability, spinal stiffness, and tenderness during spinal stiffness were observed (p-values< 0.05). At follow-up, 24% of participants were classified as 'improved'. Predictors of improvement were a greater decrease in pain intensity and in tenderness (p-values< 0.05). CONCLUSIONS In an experimental setting, the delivery of a SMT does not lead to significantly different outcomes in participants with CTP than a control condition (spinal stiffness assessment). Studies are still required to explore the mechanisms underlying SMT effects. TRIAL REGISTRATION ClinicalTrials.gov NCT03063177 , registered 24 February 2017).
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Affiliation(s)
- Isabelle Pagé
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada. .,Neuromusculoskeletal Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada. .,Present address: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Martin Descarreaux
- Neuromusculoskeletal Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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18
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Forsbrand MH, Grahn B, Hill JC, Petersson IF, Post Sennehed C, Stigmar K. Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care. BMJ Open 2018; 8:e021748. [PMID: 30580256 PMCID: PMC6318523 DOI: 10.1136/bmjopen-2018-021748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT's predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain. SETTING Prospective data from 35 primary care centres in south Sweden during 2013. PARTICIPANTS Patients (n=329) with acute/subacute back and/or neck pain, aged 18-67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11-27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%). OUTCOMES The predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC). RESULTS Based on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability. CONCLUSIONS The SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice. TRIAL REGISTRATION NUMBER NCT02609750; Results.
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Affiliation(s)
- Malin H Forsbrand
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Blekinge Centre of Competence, Landstinget Blekinge, Karlskrona, Sweden
| | - Birgitta Grahn
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Jonathan C Hill
- Research Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Ingemar F Petersson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Charlotte Post Sennehed
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Kjerstin Stigmar
- Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
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Pagé I, Nougarou F, Lardon A, Descarreaux M. Changes in spinal stiffness with chronic thoracic pain: Correlation with pain and muscle activity. PLoS One 2018; 13:e0208790. [PMID: 30533059 PMCID: PMC6289409 DOI: 10.1371/journal.pone.0208790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/25/2018] [Indexed: 01/05/2023] Open
Abstract
Objective The objective was to compare thoracic spinal stiffness between healthy participants and participants with chronic thoracic pain and to explore the associations between spinal stiffness, pain and muscle activity. The reliability of spinal stiffness was also evaluated. Material and methods Spinal stiffness was assessed from T5 to T8 using a mechanical device in 25 healthy participants and 50 participants with chronic thoracic pain (symptoms had to be reported within the evaluated region of the back). The spinal levels for which spinal stiffness was measured were standardized (i.e. T5 to T8 for all participants) to minimize between-individual variations due to the evaluation of different spinal levels. The device load and displacement data were used to calculate the global and terminal spinal stiffness coefficients at each spinal level. Immediately after each assessment, participants were asked to rate their pain intensity during the trial, while thoracic muscle activity was recorded during the load application using surface electromyography electrodes (sEMG). Within- and between-day reliability were evaluated using intraclass correlation coefficients (ICC), while the effects of chronic thoracic pain and spinal levels on spinal stiffness and sEMG activity were assessed using mixed model ANOVAs. Correlations between pain intensity, muscle activity and spinal stiffness were also computed. Results ICC values for within- and between-day reliability of spinal stiffness ranged from 0.67 to 0.91 and from 0.60 to 0.94 (except at T5), respectively. A significant decrease in the global (F1,73 = 4.04, p = 0.048) and terminal (F1,73 = 4.93, p = 0.03) spinal stiffness was observed in participants with thoracic pain. sEMG activity was not significantly different between groups and between spinal levels. Pain intensity was only significantly and "moderately" correlated to spinal stiffness coefficients at one spinal level (-0.29≤r≤-0.51), while sEMG activity and spinal stiffness were not significantly correlated. Conclusion The results suggest that spinal stiffness can be reliably assessed using a mechanical device and that this parameter is decreased in participants with chronic thoracic pain. Studies are required to determine the value of instrumented spinal stiffness assessment in the evaluation and management of patients with chronic spine-related pain.
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Affiliation(s)
- Isabelle Pagé
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- * E-mail:
| | - François Nougarou
- Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Arnaud Lardon
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Vier C, Bracht MA, Neves ML, Junkes-Cunha M, Santos ARS. Effects of spinal manipulation and pain education on pain in patients with chronic low back pain: a protocol of randomized sham-controlled trial. Integr Med Res 2018; 7:271-278. [PMID: 30271716 PMCID: PMC6160616 DOI: 10.1016/j.imr.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 02/05/2023] Open
Abstract
Background Low back pain (LBP) has more than doubled in the last 20 years, probably influenced by biopsychosocial factors. Noninvasive treatments have been applied in individuals with chronic nonspecific LBP as spinal manipulation and pain education. However, the neurophysiological effects of these treatments are not clear. The aim of this research is to verify the pain control, functional and neurophysiological effects of spinal manipulation, and pain education in individuals with chronic nonspecific LBP. Methods This research is an assessor and subject blinded, 2-arm, randomized sham-controlled trial and will be conducted at Governador Celso Ramos Hospital, Florianópolis, Brazil. One hundred and twenty-eight individuals with chronic nonspecific LBP will be recruited for this study. Individuals will be randomly allocated into one of the two groups: (1) spinal manipulation plus pain education or (2) sham treatment plus pain education. Each group will be received two sessions per week over six weeks of treatment. The measures will be applied at baseline, six weeks, and three months after randomization. The primary outcome will be a pain intensity at six weeks postrandomization. Secondary outcomes will be pressure pain threshold, disability, fear and avoidance beliefs, kinesiophobia, risk of poor prognosis, quality of life, and inflammatory biomarkers. Discussion Evidence has shown that psychosocial factors are more involved in chronic pain than we thought a few years ago. Then, studies investigating both functional and neurophysiological effects of these interventions to evaluate the effectiveness of treatment and what else is happening at the cellular level in nervous system are needed.
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Affiliation(s)
- Clécio Vier
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Marcelo Anderson Bracht
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Marcos Lisboa Neves
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Maíra Junkes-Cunha
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
| | - Adair Roberto Soares Santos
- Graduate Program in Neurosciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil.,Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Brazil
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Sowden G, Hill JC, Morso L, Louw Q, Foster NE. Advancing practice for back pain through stratified care (STarT Back). Braz J Phys Ther 2018; 22:255-264. [PMID: 29970301 PMCID: PMC6095099 DOI: 10.1016/j.bjpt.2018.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/07/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is common, however research comparing the effectiveness of different treatments over the last two decades conclude either no or small differences in the average effects of different treatments. One suggestion to explain this is that patients are not all the same and important subgroups exist that might require different treatment approaches. Stratified care for LBP involves identifying subgroups of patients and then delivering appropriate matched treatments. Research has shown that stratified care for LBP in primary care can improve clinical outcomes, reduce costs and increase the efficiency of health-care delivery in the UK. The challenge now is to replicate and evaluate this approach in other countries health care systems and to support services to implement it in routine clinical care. RESULTS The STarT Back approach to stratified care has been tested in the National Health Service, within the UK, it reduces unnecessary overtreatment in patients who have a good prognosis (those at low risk) yet increases the likelihood of appropriate healthcare and associated improved outcomes for those who are at risk of persistent disabling pain. The approach is cost-effective in the UK healthcare setting and has been recommended in recent guidelines and implemented as part of new LBP clinical pathways of care. This approach has subsequently generated international interest, a replication study is currently underway in Denmark, however, some lessons have already been learnt. There are potential obstacles to implementing stratified care in low-and-middle-income settings and in other high-income settings outside of the UK, however, implementation science literature can inform the development of innovations and efforts to support implementation of stratified care. CONCLUSIONS The STarT Back approach to stratified care for LBP is a promising method to advance practice that has demonstrated clinical and cost effectiveness in the UK. Over time, further evidence for both the effectiveness and the adaptations needed to test and implement the STarT Back stratified care approach in other countries is needed.
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Affiliation(s)
- Gail Sowden
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK; Interdisciplinary Musculoskeletal Pain Assessment and Community Treatment Service, Haywood Hospital, High Lane, Burslem, Stoke-On-Trent ST6 7AG, UK.
| | - Jonathan Charles Hill
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Lars Morso
- Centre for Quality, Department of Regional Health Research, University of Southern Denmark, Winsloewparken 19, 3 Odense C DK 5000, Denmark
| | - Quninette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nadine Elizabeth Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
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Unsgaard-Tøndel M, Kregnes IG, Nilsen TIL, Marchand GH, Askim T. Risk classification of patients referred to secondary care for low back pain. BMC Musculoskelet Disord 2018; 19:166. [PMID: 29793536 PMCID: PMC5968566 DOI: 10.1186/s12891-018-2082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/08/2018] [Indexed: 01/15/2023] Open
Abstract
Background Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. Methods An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen’s Kappa coefficient, Pearson’s r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. Results A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. Conclusion The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway. .,Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway.
| | - Ingunn Gunnes Kregnes
- Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom I L Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway.,Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Hege Marchand
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway
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Lardon A, Dubois JD, Cantin V, Piché M, Descarreaux M. Predictors of disability and absenteeism in workers with non-specific low back pain: A longitudinal 15-month study. APPLIED ERGONOMICS 2018; 68:176-185. [PMID: 29409632 DOI: 10.1016/j.apergo.2017.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/08/2017] [Accepted: 11/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of this study was to identify baseline predictors of disability and absenteeism in workers with a history of non-specific low back pain (LBP). METHODS One hundred workers with a history of non-specific LBP participated in three evaluations (baseline, 7 and 15 months follow-up). Current and past history of LBP, clinical pain intensity, disability, absenteeism, fear-avoidance beliefs, pain catastrophizing, pain hypervigilance, work satisfaction and patient stratification based on "risk of poor clinical outcome assessment" (RPCO) were evaluated using questionnaires and interviews. In addition, cutaneous heat pain thresholds, cutaneous heat pain tolerance thresholds, conditioned pain modulation (CPM), trunk kinematics and muscle activity were measured during each evaluation. Logistic regression models were used to determine predictors of LBP disability and absenteeism at 15-months. RESULTS Sixty-eight workers returned for the 15-month follow-up and among this sample, 49% reported disability and 16% reported absenteeism at follow-up. Baseline clinical pain intensity predicted disability (OR = 1.08, 95%CI: 1.03-1.13) at 15-month while work satisfaction (OR = 0.93, 95%CI: 0.87-0.99) and RPCO (OR = 1.51, 95%CI: 1.05-2.16) predicted absenteeism. These results remained significant after adjustments for age, gender as well as type of work and intervention. CONCLUSION This study highlights the importance of clinical pain and psychological factors in the prediction and potentially the prevention of future disability. Screening tools assessing these risk factors can be useful to evaluate workers with past history of low back pain.
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Affiliation(s)
- Arnaud Lardon
- Département des Sciences de l'Activité Physique, Canada; Institut Franco-Européen de Chiropraxie, Paris, France
| | - Jean-Daniel Dubois
- Département des Sciences de l'Activité Physique, Canada; Département de Psychologie, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Canada; Groupe de Recherche en Cognition, Neurosciences, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal - CRIUGM, Université de Montréal, Canada
| | - Vincent Cantin
- Département des Sciences de l'Activité Physique, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Canada
| | - Mathieu Piché
- Département de Chiropratique, Canada; Groupe de Recherche en Cognition, Neurosciences, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal - CRIUGM, Université de Montréal, Canada
| | - Martin Descarreaux
- Département des Sciences de l'Activité Physique, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Canada.
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Validity and reproducibility of the modified STarT Back Tool (Dutch version) for patients with neck pain in primary care. Musculoskelet Sci Pract 2017. [PMID: 28644962 DOI: 10.1016/j.msksp.2017.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the reliability and validity of the Dutch version of the STarT Back screening Tool (SBT), for patients with neck pain. METHODS We modified the SBT to fit patients with neck pain. General practitioners and physiotherapists included patients who completed both a baseline and a follow-up questionnaire at 3 days and 3 months, respectively. The construct validity was assessed using Pearson's correlation between the SBT and the reference questionnaires. The reproducibility was assessed in the first week using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using a relative-risk ratio (RR) for, amongst others, persisting disability at 3 months. Content validity was analysed using both floor and ceiling effects. RESULTS In total, 100 patients were included; 58% were categorised as being at "low risk" for persisting disability, 37% at "medium risk" and 5% at "high risk". As expected for the construct validity, we found a moderate to high correlation for all questions except for activity question 3. The reproducibility had a quadratic-weighted kappa of 0.58, and a specific agreement of 90.9% for "low-risk" and 66.7% for "medium-risk" patients. The RRs for persisting disability for "medium-risk" against "low-risk" patients were 1.5 (95% C.I. 0.9-2.4) and 1.5 (95% C.I. 0.5-4.1) for pain. The sample size for high-risk patients was low. CONCLUSION The original SBT is modified to fit patients with neck pain in Dutch primary care. The psychometric analysis indicates sufficiently reliable outcomes, although the predictive validity showed statistically insignificant results.
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Evaluation of Cross-Cultural Adaptation and Measurement Properties of STarT Back Screening Tool: A Systematic Review. J Manipulative Physiol Ther 2017; 40:558-572. [DOI: 10.1016/j.jmpt.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
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Post Sennehed C, Gard G, Holmberg S, Stigmar K, Forsbrand M, Grahn B. "Blue flags", development of a short clinical questionnaire on work-related psychosocial risk factors - a validation study in primary care. BMC Musculoskelet Disord 2017; 18:318. [PMID: 28738803 PMCID: PMC5525291 DOI: 10.1186/s12891-017-1677-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Working conditions substantially influence health, work ability and sick leave. Useful instruments to help clinicians pay attention to working conditions are lacking in primary care (PC). The aim of this study was to test the validity of a short “Blue flags” questionnaire, which focuses on work-related psychosocial risk factors and any potential need for contacts and/or actions at the workplace. Methods From the original“The General Nordic Questionnaire” (QPSNordic) the research group identified five content areas with a total of 51 items which were considered to be most relevant focusing on work-related psychosocial risk factors. Fourteen items were selected from the identified QPSNordic content areas and organised in a short questionnaire “Blue flags”. These 14 items were validated towards the 51 QPSNordic items. Content validity was reviewed by a professional panel and a patient panel. Structural and concurrent validity were also tested within a randomised clinical trial. Results The two panels (n = 111) considered the 14 psychosocial items to be relevant. A four-factor model was extracted with an explained variance of 25.2%, 14.9%, 10.9% and 8.3% respectively. All 14 items showed satisfactory loadings on all factors. Concerning concurrent validity the overall correlation was very strong rs = 0.87 (p < 0.001).). Correlations were moderately strong for factor one, rs = 0.62 (p < 0.001) and factor two, rs = 0.74 (p < 0.001). Factor three and factor four were weaker, bur still fair and significant at rs = 0.53 (p < 0.001) and rs = 0.41 (p < 0.001) respectively. The internal consistency of the whole “Blue flags” was good with Cronbach’s alpha of 0.76. Conclusions The content, structural and concurrent validity were satisfactory in this first step of development of the “Blue flags” questionnaire. In summary, the overall validity is considered acceptable. Testing in clinical contexts and in other patient populations is recommended to ensure predictive validity and usefulness.
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Affiliation(s)
- Charlotte Post Sennehed
- Department of Clinical Sciences Lund, Lund University, Orthopedics, Lund, Sweden. .,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Box 1223, 35112, Växjö, Sweden.
| | - Gunvor Gard
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Box 1223, 35112, Växjö, Sweden.,Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Malin Forsbrand
- Department of Clinical Sciences Lund, Lund University, Orthopedics, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Blekinge Centre of Competence, Landstinget Blekinge, Karlskrona, Sweden
| | - Birgitta Grahn
- Department of Clinical Sciences Lund, Lund University, Orthopedics, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Box 1223, 35112, Växjö, Sweden
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Bier JD, Ostelo RWJG, van Hooff ML, Koes BW, Verhagen AP. Validity and Reproducibility of the STarT Back Tool (Dutch Version) in Patients With Low Back Pain in Primary Care Settings. Phys Ther 2017; 97:561-570. [PMID: 28340202 DOI: 10.1093/ptj/pzx023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to translate and to investigate the reliability and validity of the STarT Back screening tool (SBT) in the primary care setting among patients with nonspecific low back pain (LBP). DESIGN The SBT was formally translated into Dutch following a multistep approach for forward and backward translation. General practitioners and physical therapists included patients with LBP. METHODS Patients completed a baseline questionnaire and a follow-up at 3 days and 3 months. The construct validity was calculated with Pearson's correlation coefficient. The reproducibility was assessed using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using relative risk ratios for persisting disability at 3 months. Content validity was analyzed using floor and ceiling effects. RESULTS In total, 184 patients were included; 52.2% were categorized in the "low-risk" subgroup, 38.0% "medium-risk," and 9.8% "high-risk." For the construct validity we found, as expected, a moderate to high Pearson's correlation for questions 3 to 9 and a low correlation for questions 1 and 2 with their respective reference questionnaires. The reproducibility had a quadratic weighted kappa of 0.65 and the specific agreement of 82.4% for "low-risk," 53.3% for "medium-risk," and 33.3% for "high-risk." For the predictive validity for persisting disability we found a relative risk ratio for "medium-risk" of 1.8 (95% confidence interval [CI]: 1.0-3.1) and 2.7 (95% CI: 1.4-4.9) for "high-risk" compared with "low-risk." For the content validity, we found that no floor and ceiling effects were present. LIMITATIONS There was a relatively small sample size for the retest reliability study. Patients were not compared between physical therapist and GP, as there were not enough patients in both groups. For practical reasons, the patients filled out the baseline questionnaire after receiving the first treatment/consultation; however, the questionnaire is intended to be filled in before the first consultation/treatment. CONCLUSION The SBT has been successfully translated into Dutch. The psychometric analysis showed acceptable results and, therefore, the SBT is a valid screening tool for patients with LBP in Dutch primary care.
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Affiliation(s)
- Jasper D Bier
- Department of General Practice, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, the Netherlands, and Fysiotherapie Fascinatio, Capelle aan den Ijssel, the Netherlands
| | - Raymond W J G Ostelo
- Department of Epidemiology and Biostatistics, VU University Medical Centre; EMGO Institute for Health and Care Research; and Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
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Longitudinal Monitoring of Patients With Chronic Low Back Pain During Physical Therapy Treatment Using the STarT Back Screening Tool. J Orthop Sports Phys Ther 2017; 47:314-323. [PMID: 28355979 DOI: 10.2519/jospt.2017.7199] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Preplanned secondary analysis of a randomized clinical trial. Background The STarT Back Screening Tool (SBST) was developed to screen and to classify patients with low back pain into subgroups for the risk of having a poor prognosis. However, this classification at baseline does not take into account variables that can influence the prognosis during treatment or over time. Objectives (1) To investigate the changes in risk subgroup measured by the SBST over a period of 6 months, and (2) to assess the long-term predictive ability of the SBST when administered at different time points. Methods Patients with chronic nonspecific low back pain (n = 148) receiving physical therapy care as part of a randomized trial were analyzed. Pain intensity, disability, global perceived effect, and the SBST were collected at baseline, 5 weeks, 3 months, and 6 months. Changes in SBST risk classification were calculated. Hierarchical linear regression models adjusted for potential confounders were built to analyze the predictive capabilities of the SBST when administered at different time points. Results A large proportion of patients (60.8%) changed their risk subgroup after receiving physical therapy care. The SBST improved the prediction for all 6-month outcomes when using the 5-week risk subgroup and the difference between baseline and 5-week subgroup, after controlling for potential confounders. The SBST at baseline did not improve the predictive ability of the models after adjusting for confounders. Conclusion This study shows that many patients change SBST risk subgroup after receiving physical therapy care, and that the predictive ability of the SBST in patients with chronic low back pain increases when administered at different time points. Level of Evidence Prognosis, 2b. J Orthop Sports Phys Ther 2017;47(5):314-323. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7199.
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The Japanese version of the STarT Back Tool predicts 6-month clinical outcomes of low back pain. J Orthop Sci 2017; 22:224-229. [PMID: 28025022 DOI: 10.1016/j.jos.2016.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The STarT Back Tool classifies patients into low-, medium-, or high-risk groups according to risk for chronic low back pain. The Japanese version of the STarT Back Tool (STarT-J) has been translated and psychometrically validated. The present analysis investigated the predictive ability of the STarT-J. METHODS Baseline data were collected through an online survey conducted with Japanese patients with low back pain. Long-term outcomes were assessed in a 6-month follow-up survey. Clinical outcomes at 6 months were evaluated with a pain numerical rating scale, the Roland-Morris Disability Questionnaire, and the EuroQol 5 Dimension. Differences in these scores among the three STarT-J risk groups were analyzed. Participants' perceived changes in low back pain and overall health status were examined to determine associations between the chronicity of low back pain at 6 months and STarT-J risk groups. RESULTS Data of 1228 volunteers who responded to the baseline and follow-up surveys were included in this analysis. Mean ± standard deviation (SD) scores for the pain numerical rating scale and the Roland-Morris Disability Questionnaire were highest in the high-risk group (5.6 ± 1.9 and 9.6 ± 7.5) and lowest in the low-risk group (3.9 ± 1.6 and 2.1 ± 3.5). Mean ± SD EuroQol 5 Dimension index scores were lowest in the high-risk group (0.66 ± 0.20) and highest in the low-risk group (0.86 ± 0.14). A small percentage of high-risk patients (5.3%) perceived improvement in low back pain at the 6-month follow-up. CONCLUSIONS The STarT-J predicted 6-month pain and disability outcomes. The STarT-J is an easy-to-use tool to screen for patients who are more likely to have chronic low back pain, and may be useful to initiate stratified care in primary care settings.
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Forsbrand M, Grahn B, Hill JC, Petersson IF, Sennehed CP, Stigmar K. Comparison of the Swedish STarT Back Screening Tool and the Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire in patients with acute or subacute back and neck pain. BMC Musculoskelet Disord 2017; 18:89. [PMID: 28222707 PMCID: PMC5320684 DOI: 10.1186/s12891-017-1449-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/09/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with back and neck pain are often seen in primary care and it is important to provide them with tailored interventions based on risk stratification/triage. The STarT Back Screening Tool (SBT) is a widely used screening questionnaire which has not yet been validated for a population with back and/or neck pain with short duration. Our aim was to compare the concurrent validity of the SBT and the short form of the ÖMPSQ including psychometric properties and clinical utility in a primary care setting. METHODS Patients who applied for physiotherapy by direct access (January 2013 to January 2014) at 35 primary care centers in south Sweden, with acute or subacute back and/or neck pain, aged 18-67 years, who were not currently on sick leave or had been on sick leave less than 60 days were asked to complete the SBT and ÖMPSQ-short questionnaire (n = 329). We used the Spearman's rank correlations to study correlations, cross tabulation and Cohen's kappa to analyze agreement of patient classification. Clinical utility was described as clinician scoring miscalculations and misclassifications of total and/or subscale scores. RESULTS Completed SBT (9-items) and ÖMPSQ-short (10-items) data were available for 315/329 patients respectively. The statistical correlation for SBT and ÖMPSQ-short total scores was moderately strong (0.62, p < 0.01). In subgroup analyses, the correlations were 0.69 (p < 0.01) for males and 0.57 (p < 0.01) for females. The correlations were lower among older age groups, especially females over 50 years (0.21, p = 0.11). Classification to high or low risk for long-term pain and disability had moderate agreement (κ = 0.42). Observed classification agreement was 70.2%. The SBT had fewer miscalculations (13/315) than the ÖMPSQ-short (54/315). CONCLUSIONS The correlation between the SBT and the ÖMPSQ-short scores were moderately strong for individuals with acute or subacute back and/or neck pain. SBT seemed to be clinically feasible to use in clinical practice. We therefore suggest that SBT can be used for individuals with both BP and/or NP in primary care settings but it is important to be aware of that SBT's agreement with the ÖMPSQ-short was poor among females aged over 50 years. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02609750 Registered: November 18, 2015.
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Affiliation(s)
- Malin Forsbrand
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden. .,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden. .,Blekinge Centre of Competence, Landstinget Blekinge, SE-371 81, Karlskrona, Sweden.
| | - Birgitta Grahn
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Jonathan C Hill
- Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Ingemar F Petersson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Charlotte Post Sennehed
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden.,Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Kjerstin Stigmar
- Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
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Pilz B, Vasconcelos RA, Teixeira PP, Mello W, Marcondes FB, Hill JC, Grossi DB. Construct and discriminant validity of STarT Back Screening Tool - Brazilian version. Braz J Phys Ther 2017; 21:69-73. [PMID: 28442077 PMCID: PMC5537440 DOI: 10.1016/j.bjpt.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022] Open
Abstract
SBST-Brazil showed a moderate to good correlation with disability tools. SBST-Brazil demonstrated weak correlations with fear-avoidance beliefs. SBST-Brazil discriminates LBP patients with disability and fear-avoidance beliefs.
Background The STarT Back Screening Tool (SBST) was developed to stratify low back pain patients according to their risk of future physical disability so that prognostic subgroups can receive matched treatments in primary care. Objective To measure the construct and discriminative validity of the SBST-Brazil questionnaire. Method A hundred and fifty one patients were recruited to test the construct and discriminative validity comparing the SBST-Brazil to the Brazilian Version of the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) and Fear-Avoidance Beliefs Questionnaire-Work (FABQ-W) and Physical Activity (FABQ-PA) subscales at baseline. Spearman's rank-order correlation and area under the curve (AUC) derived from receiver operating curves (ROC) for total scores and psychosocial subscale score of the SBST-Brazil were used for construct and discriminant validity analysis, respectively. Results The SBST-Brazil total and psychosocial subscale scores had good and moderate correlation with ODI (r = 0.61; r = 0.56, respectively) and good with RMDQ (r = 0.70; r = 0.64, respectively). Both scores of the SBST-Brazil total and psychosocial subscale correlated weakly and moderately with the FABQ-PA (r = 0.28; r = 0.34, respectively) and weakly with the FABQ-W (r = 0.18; r = 0.20, respectively). The discriminant validity with AUCs for the total and psychosocial subscale scores against reference standard ranged from 0.66 for kinesiophobia to 0.88 for disability. Conclusion The SBST-Brazil showed a moderate to good correlation with the disability tools, but a weak correlation with fear-avoidance beliefs. The results of discriminant validity suggest that SBST-Brazil is able to discriminate low back pain patients with disability and fear-avoidance beliefs.
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Affiliation(s)
- Bruna Pilz
- Núcleo de Estudos e pesquisa, Instituto Wilson Mello, Campinas, São Paulo, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | - Rodrigo A Vasconcelos
- Núcleo de Estudos e pesquisa, Instituto Wilson Mello, Campinas, São Paulo, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Paulo P Teixeira
- Núcleo de Estudos e pesquisa, Instituto Wilson Mello, Campinas, São Paulo, Brazil; Departamento de Ortopedia, Grupo do Joelho de Campinas (GJC), Campinas, SP, Brazil
| | - Wilson Mello
- Núcleo de Estudos e pesquisa, Instituto Wilson Mello, Campinas, São Paulo, Brazil; Departamento de Ortopedia, Grupo do Joelho de Campinas (GJC), Campinas, SP, Brazil
| | - Freddy B Marcondes
- Núcleo de Estudos e pesquisa, Instituto Wilson Mello, Campinas, São Paulo, Brazil; Departamento de Ciências da Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Jonathan C Hill
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Débora B Grossi
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Gross DP, Armijo-Olivo S, Shaw WS, Williams-Whitt K, Shaw NT, Hartvigsen J, Qin Z, Ha C, Woodhouse LJ, Steenstra IA. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:286-318. [PMID: 26667939 PMCID: PMC4967425 DOI: 10.1007/s10926-015-9614-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each of these areas and the associated evidence are described. The state of evidentiary support for CDS tools is still preliminary and lacks external validation, head-to-head comparisons, or evidence of generalizability across different populations and settings. Conclusions CDS tools, especially those employing rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation before they can be recommended for large-scale implementation for managing patients with MSK disorders.
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Affiliation(s)
- Douglas P. Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - William S. Shaw
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748 USA
| | - Kelly Williams-Whitt
- University of Lethbridge, Calgary Campus, Suite S6032, 345 - 6th Avenue SE, Calgary, AB T2G 4V1 Canada
| | - Nicola T. Shaw
- Algoma University, 1520 Queen Street East, CC 303, Sault Ste. Marie, ON P2A 2G4 Canada
| | - Jan Hartvigsen
- University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Ziling Qin
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Christine Ha
- Faculty of Rehabilitation Medicine, University of Alberta, 3-62 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Linda J. Woodhouse
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada
| | - Ivan A. Steenstra
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON M5G 2E9 Canada
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Matsudaira K, Oka H, Kikuchi N, Haga Y, Sawada T, Tanaka S. Psychometric Properties of the Japanese Version of the STarT Back Tool in Patients with Low Back Pain. PLoS One 2016; 11:e0152019. [PMID: 27002823 PMCID: PMC4803233 DOI: 10.1371/journal.pone.0152019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/08/2016] [Indexed: 12/19/2022] Open
Abstract
Background and Objective The 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). Methods An 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. Results The 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. Conclusions The 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.
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Affiliation(s)
- Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Norimasa Kikuchi
- Clinical Study Support, Inc., Nagoya, Aichi, Japan
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Yuri Haga
- Clinical Study Support, Inc., Nagoya, Aichi, Japan
| | - Takayuki Sawada
- Clinical Study Support, Inc., Nagoya, Aichi, Japan
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abedi M, Manshadi FD, Khalkhali M, Mousavi SJ, Baghban AA, Montazeri A, Parnianpour M. Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain. ACTA ACUST UNITED AC 2015; 20:850-4. [DOI: 10.1016/j.math.2015.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
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Karstens S, Krug K, Hill JC, Stock C, Steinhaeuser J, Szecsenyi J, Joos S. Validation of the German version of the STarT-Back Tool (STarT-G): a cohort study with patients from primary care practices. BMC Musculoskelet Disord 2015; 16:346. [PMID: 26559635 PMCID: PMC4642614 DOI: 10.1186/s12891-015-0806-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022] Open
Abstract
Background Current research emphasizes the high prevalence and costs of low back pain (LBP). The STarT Back Tool was designed to support primary care decision making for treatment by helping to determine the treatment prognosis of patients with non-specific low back pain. The German version is the STarT-G. The cross-cultural translation of the tool followed a structured and widely accepted process but to date it was only partially validated with a small sample. The aim of the study was to test the psychometric properties construct validity, discriminative ability, internal consistency and test-retest-reliability of the STarT-G and to compare them with values given for the original English version. Methods A consecutive cohort study with a two-week retest was conducted among patients with non-specific LBP, aged 18 to 60 years, from primary care practices. Questionnaires were collected before the first consultation, and two weeks later by post, using the following reference standards: the Roland and Morris disability questionnaire, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale and the Hospital Anxiety and Depression Scale. Psychometric properties examined included the tool’s discriminative abilities, whether the psychosocial subscale was one factor, internal consistency, item redundancy, test-retest reliability and floor and ceiling effects. Results There were 228 patients recruited with a mean age of 42.2 (SD 11.0) years, and 53 % were female. The areas under the curve (AUC) for discriminative ability ranged from 0.70 (STarT-G Subscale - Pain Catastrophizing Scale; CI95 0.63, 0.78) to 0.77 (STarT-G Total - Composite reference standard, CI95 0.60, 0.94). Factor loadings ranged from 0.49 to 0.74. Cronbach’s alpha testing the internal consistency and redundancy for the total/subscale scores were α = 0.52/0.55 respectively. The STarT-G test-retest reliability Kappa values for the total/subscale scores were 0.67/0.68 respectively. No floor or ceiling effects were present. Conclusions The STarT-G shows acceptable psychometric properties although not in exact agreement with the original English version. The items previously regarded as a psychosocial subscale may be better seen as an index of different individual psychosocial constructs. The relevance of using the tool at the point of consultation should be further examined.
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Affiliation(s)
- Sven Karstens
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonathan C Hill
- Institute of Primary Care and Health Sciences, Keele University, Keele/Stoke-on-Trent, United Kingdom
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jost Steinhaeuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Joos
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
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Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M. Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study. BMC Musculoskelet Disord 2015; 16:201. [PMID: 26286385 PMCID: PMC4541753 DOI: 10.1186/s12891-015-0669-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated. METHODS Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST. RESULTS The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (|τ| = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05). CONCLUSION Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year. TRIAL REGISTRATION Clinicaltrials.gov NCT02226692.
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Affiliation(s)
- Isabelle Pagé
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada.
| | - Jacques Abboud
- Département d'anatomie, UQTR, Trois-Rivières, Québec, Canada.
| | - Julie O Shaughnessy
- Département de chiropratique, UQTR, Trois-Rivières, Québec, Canada. Julie.O'
| | - Louis Laurencelle
- Département des sciences de l'activité physique, UQTR, Trois-Rivières, Québec, Canada.
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, Trois-Rivières, G9A 5H7, Québec, Canada.
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Simons LE, Smith A, Ibagon C, Coakley R, Logan DE, Schechter N, Borsook D, Hill JC. Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints. Pain 2015; 156:1511-1518. [PMID: 25906349 PMCID: PMC4504741 DOI: 10.1097/j.pain.0000000000000199] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion dollars annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision making. Youth (n = 321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (78%, 68%) and high emotional distress (81%, 63%). Participants were classified into low- (11%), medium- (32%), and high- (57%) risk groups. Risk groups did not significantly differ by pain diagnosis, location, or duration. Only 2% to 7% of patients who met reference standard case status for disability and emotional distress at 4-month follow-up were classified as low risk at baseline, whereas 71% to 79% of patients who met reference standard case status at follow-up were classified as high risk at baseline. A 9-item screening tool identifying factors associated with adverse outcomes among youth who present with pain complaints seems valid and provides risk stratification that can potentially guide effective pain treatment recommendations in the clinic setting.
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Affiliation(s)
- Laura E. Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
- Department of Psychiatry, Harvard Medical School, Keele University, UK
- P.A.I.N. Group, Boston Children's Hospital and Center for Pain and the Brain, Keele University, UK
| | - Allison Smith
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
- Department of Psychiatry, Harvard Medical School, Keele University, UK
| | - Camila Ibagon
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
| | - Rachael Coakley
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
- Department of Psychiatry, Harvard Medical School, Keele University, UK
| | - Deirdre E. Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
- Department of Psychiatry, Harvard Medical School, Keele University, UK
| | - Neil Schechter
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
| | - David Borsook
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Keele University, UK
- P.A.I.N. Group, Boston Children's Hospital and Center for Pain and the Brain, Keele University, UK
| | - Jonathan C Hill
- P.A.I.N. Group, Boston Children's Hospital and Center for Pain and the Brain, Keele University, UK
- Arthritis Research UK Primary Care Centre, Keele University, UK
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Morso L, Kongsted A, Hestbaek L, Kent P. The prognostic ability of the STarT Back Tool was affected by episode duration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:936-44. [PMID: 25835771 DOI: 10.1007/s00586-015-3915-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The prognostic ability of the STarT Back Tool (SBT) reportedly varies, but the factors affecting this are unclear. This study investigated the influences of care setting (chiropractic, GP, physiotherapy, spine centre), episode duration (0-2, 3-4, 4-12, >12 weeks), and outcome time period (3, 6, 12 months) on SBT prognostic ability. METHODS This was a secondary analysis of data from three primary care cohorts [chiropractic (n = 416), GP (n = 265), and physiotherapy (n = 200) practices] and one cohort from a secondary care outpatient spine centre (n = 974) in Denmark. Care pathways were not systematically affected by SBT risk subgroup (non-stratified care). Using generalised estimating equations, we investigated statistical interactions between SBT risk subgroups and potentially influential factors on the prognostic ability of the SBT subgroups, when Roland Morris Disability Questionnaire scores were the outcome. RESULTS SBT risk subgroup, age, care setting, and episode duration were all independent prognostic factors. The only investigated factor that modified the prognostic ability of the SBT subgroups was episode duration. CONCLUSIONS These results indicate that the prognostic ability of the SBT in these non-stratified care settings was unaffected by care setting on its own. However, the prognosis of patients is affected by diverse clinical characteristics that differ between patient populations, many of which are not assessed by the SBT. When controlling for some of those factors and testing potential interactions, the results showed that only episode duration affected the SBT prognostic ability and, specifically, that the SBT was less predictive in very acute patients (<2 weeks duration).
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Affiliation(s)
- Lars Morso
- Centre for Quality, Region of Southern Denmark, P.V. Tuxensvej 5, 5500, Middelfart, Denmark.
| | - Alice Kongsted
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lise Hestbaek
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Transcultural adaption and psychometric properties of the STarT Back Screening Tool among Finnish low back pain patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:287-295. [DOI: 10.1007/s00586-015-3804-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/26/2022]
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Betten C, Sandell C, Hill JC, Gutke A. Cross-cultural adaptation and validation of the Swedish STarT Back Screening Tool. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2014.1003962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pilz B, Vasconcelos RA, Marcondes FB, Lodovichi SS, Mello W, Grossi DB. The Brazilian version of STarT Back Screening Tool - translation, cross-cultural adaptation and reliability. Braz J Phys Ther 2014; 18:453-61. [PMID: 25372008 PMCID: PMC4228631 DOI: 10.1590/bjpt-rbf.2014.0028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022] Open
Abstract
Background: Psychosocial factors are not routinely identified in physical therapy
assessments, although they can influence the prognosis of patients with low back
pain. The "STarT Back Screening Tool" (SBST) questionnaire aids in screening such
patients for poor prognosis in the primary care setting and classifies them as
high, medium, or low risk based on physical and psychosocial factors. Objectives: This study sought to translate and cross-culturally adapt the SBST to the
Brazilian Portuguese language and test the reliability of the Brazilian version.
Method: The first stage of the study consisted of the translation, synthesis, and
back-translation of the original version of the STSB, including revision by the
Translation Group, pretest of the translated version, and assessment by an expert
panel. The pre-final Brazilian version was applied to 2 samples comprising 52
patients with low back pain; these patients were of both genders and older than 18
years of age. To assess the instrument's reliability, an additional sample
comprising 50 patients was subjected to 2 interviews, and the results were
assessed using the quadratic weighted kappa value. The instrument's internal
consistency was assessed using Cronbach's alpha (n=105), and the standard error of
measurement was also calculated (n=50). Results: Translation and back-translation attained consensus, and only item 6 required
changes; the reformulated version was applied to an additional sample comprising
52 individuals who did not report any doubts related to this item. The reliability
of the SBST-Brazil was 0.79 (95% confidence interval: 0.63-0.95), the internal
consistency was 0.74 for the total score and 0.72 for the psychosocial subscale,
and the standard error of measurement was 1.9%. Conclusion: The translated and cross-culturally adapted SBST-Brazil proved to be reliable for
screening patients according to their risk of poor prognosis and the presence of
psychosocial factors.
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Affiliation(s)
- Bruna Pilz
- Instituto Wilson Mello, Campinas, SP, Brazil
| | | | | | - Samuel S Lodovichi
- Centro Universitário da Fundação Educacional de Guaxupé, Guaxupé, MG, Brazil
| | | | - Débora B Grossi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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