Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings

Beneciuk, Jason M; Michener, Lori A; Sigman, Erica; Harrison, Trent; Buzzanca-Fried, Katherine E; Lu, Xinlin; Shan, Guogen; Hill, Jonathan C

Abstract

The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low < medium-or-high; P < .01). For predictive validity, intake STarT MSK tool scores explained additional variability in pain intensity (11.2%, 20.0%), pain interference (7.5%, 14.1%), and SF-8 PCS (8.2%, 12.8%) scores at 2 and 6 months, respectively. This study contributes to the existing literature by providing additional evidence of STarT MSK tool cross-sectional construct validity and longitudinal predictive validity. PERSPECTIVE: This study presents STarT MSK risk stratification tool validity findings from a U.S. outpatient physical therapy sample. The STarT MSK tool has the potential to help physical therapists identify individuals presenting with the most common MSK pain conditions who may require more targeted interventions or closer monitoring. [Abstract copyright: Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.]

Citation

Beneciuk, J. M., Michener, L. A., Sigman, E., Harrison, T., Buzzanca-Fried, K. E., Lu, X., Shan, G., & Hill, J. C. (2024). Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings. The Journal of Pain, 25(7), Article 104475. https://doi.org/10.1016/j.jpain.2024.01.340

• Journal Article Type: Article
• Acceptance Date: Jan 10, 2024
• Online Publication Date: Jan 17, 2024
• Publication Date: 2024-07
• Deposit Date: Apr 15, 2024
• Journal: The Journal of Pain
• Electronic ISSN: 1526-5900
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 7
• Article Number: 104475
• DOI: https://doi.org/10.1016/j.jpain.2024.01.340
• Keywords: physical therapy, Risk stratification, musculoskeletal pain, prognosis, screening
• Public URL: https://keele-repository.worktribe.com/output/721533
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S152659002400347X?via%3Dihub
• Related Public URLs: https://www.jpain.org/article/S1526-5900(24)00347-X/pdf