The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study

Hill, Jonathan

Abstract

Questions
In people with chronic non-specific low back pain (LBP), what is the predictive and discriminative validity of the STarT Back Tool (SBT) for pain intensity, self-reported LBP-related disability, and global self-perceived change at 1-year follow-up? What is the profile of the SBT risk subgroups with respect to demographic variables, pain intensity, self-reported LBP-related disability, and psychological measures?

Design
Prospective cohort study.

Participants
A total of 290 adults with dominant axial LBP of = 3 months’ duration recruited from the general community, and private physiotherapy, psychology, and pain-management clinics in Western Australia.

Outcome measures
The 1-year follow-up measures were pain intensity, LBP-related disability, and global self-perceived change.

Results
Outcomes were collected on 264 participants. The SBT categorised 82 participants (28%) as low risk, 116 (40%) as medium risk, and 92 (32%) as high risk. The risk subgroups differed significantly (p < 0.05) on baseline pain, disability, and psychological scores. The SBT’s predictive ability was strongest for disability: RR was 2.30 (95% CI 1.28 to 4.10) in the medium-risk group and 2.86 (95% CI 1.60 to 5.11) in the high-risk group. The SBT’s predictive ability was weaker for pain: RR was 1.25 (95% CI 1.04 to 1.51) in the medium-risk group and 1.26 (95% CI 1.03 to 1.52) in the high-risk group. For the SBT total score, the AUC was 0.71 (95% CI 0.64 to 0.77) for disability and 0.63 (95% CI 0.55 to 0.71) for pain.

Conclusion
This was the first large study to investigate the SBT in a population exclusively with chronic LBP. The SBT provided an acceptable indication of 1-year disability, had poor predictive and discriminative ability for future pain, and was unable to predict or discriminate global perceived change. In this cohort with chronic non-specific LBP, the SBT’s predictive and discriminative abilities were restricted to disability at 1 year. [Kendell M, Beales D, O’Sullivan P, Rabey M, Hill J, Smith A (2018) The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study. Journal of Physiotherapy 64: 107–113]

Citation

Hill, J. (2018). The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study. Journal of Physiotherapy, 107-113. https://doi.org/10.1016/j.jphys.2018.02.009

• Acceptance Date: Mar 27, 2018
• Publication Date: Apr 1, 2018
• Journal: Journal of Physiotherapy
• Print ISSN: 1836-9553
• Publisher: Elsevier
• Pages: 107-113
• DOI: https://doi.org/10.1016/j.jphys.2018.02.009
• Keywords: Low pack pain, Decision support techniques, Prognosis, Validation studies
• Publisher URL: http://dx.doi.org/10.1016/j.jphys.2018.02.009