Advertisement

European Spine Journal

, Volume 25, Issue 3, pp 936–944 | Cite as

The prognostic ability of the STarT Back Tool was affected by episode duration

  • Lars MorsoEmail author
  • Alice Kongsted
  • Lise Hestbaek
  • Peter Kent
Original Article

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).

Keywords

STarT Back Tool Prognosis Back pain Prediction Care settings 

Notes

Acknowledgments

We thank all the clinicians who took part in the data collection.

Conflict of interest

None.

References

  1. 1.
    Hayden JA, Dunn KM, van der Windt DA, Shaw WS (2010) What is the prognosis of back pain? Best Pract Res Clin Rheumatol 24:167–179CrossRefPubMedGoogle Scholar
  2. 2.
    Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R (2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum 64:2028–2037CrossRefPubMedGoogle Scholar
  3. 3.
    Foster NE, Hill JC, O’Sullivan P, Hancock M (2013) Stratified models of care. Best Pract Res Clin Rheumatol 27:649–661CrossRefPubMedGoogle Scholar
  4. 4.
    Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM (2008) A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 59(5):632–641CrossRefPubMedGoogle Scholar
  5. 5.
    Pransky G, Borkan JM, Young AE, Cherkin DC (2011) Are we making progress?: the tenth international forum for primary care research on low back pain. Spine (Phila Pa 1976) 36:1608–1614CrossRefGoogle Scholar
  6. 6.
    Bruyere O, Demoulin M, Brereton C, Humblet F, Flynn D, Hill JC, Maquet D, Van BJ, Reginster JY, Crielaard JM, Demoulin C (2012) Translation validation of a new back pain screening questionnaire (the STarT Back Screening Tool) in French. Arch Public Health 7(70):12. doi: 10.1186/0778-7367-70-12 CrossRefGoogle Scholar
  7. 7.
    Bruyere O, Demoulin M, Beaudart C, Hill JC, Maquet D, Genevay S, Mahieu G, Reginster JY, Crielaard JM, Demoulin C (2013) Validity and Reliability of the French version of the STarT Back Screening Tool for patients with low back pain. Spine (Phila Pa 1976) 39(2):123–128CrossRefGoogle Scholar
  8. 8.
    Gusi N, Del Pozo-Cruz B, Olivares PR, Hernandez-Mocholi M, Hill JC (2011) The Spanish version of the “STarT Back Screening Tool” (SBST) in different subgroups. Aten Primaria 43(7):356–361. doi: 10.1016/j.aprim.2010.05.019 CrossRefPubMedGoogle Scholar
  9. 9.
    Morso L, Albert H, Kent P, Manniche C, Hill J (2011) Translation and discriminative validation of the STarT Back Screening Tool into Danish. Eur Spine J 20(12):2166–2173. doi: 10.1007/s00586-011-1911-6 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Field J, Newell D (2012) Relationship between STarT Back Screening Tool and prognosis for low back pain patients receiving spinal manipulative therapy. Chiropr Man Therap 20(1):17. doi: 10.1186/2045-709X-20-17 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Morso L, Kent P, Albert HB, Hill JC, Kongsted A, Manniche C (2013) The predictive and external validity of the STarT Back Tool in Danish primary care. Eur Spine J 22(8):1859–1867. doi: 10.1007/s00586-013-2690-z CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Morso L, Kent P, Manniche C, Albert HB (2013) The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting. Eur Spine J 23(1):120–128. doi: 10.1007/s00586-013-2861-y CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bekkering GE, Hendriks HJ, van Tulder MW, Knol DL, Simmonds MJ, Oostendorp RA, Bouter LM (2005) Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques. Spine (Phila Pa 1976) 30:1881–1886CrossRefGoogle Scholar
  14. 14.
    Coste J, Delecoeuillerie G, de Cohen LA, Le Parc JM, Paolaggi JB (1994) Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. BMJ 308:577–580CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Newell D, Field J, Pollard D (2014) Using the STarT Back Tool: Does timing of stratification matter? Man Ther. doi: 10.1016/j.math.2014.08.001 Google Scholar
  16. 16.
    Hestbaek L, Munck A, Hartvigsen L, Jarbøl D, Søndergaard Kongsted A (2014) Low Back Pain in Primary care: a description of 1250 patients with low back pain in Danish general and chiropractic practice. Int J Family Med. doi: 10.1155/2014/106102 PubMedPubMedCentralGoogle Scholar
  17. 17.
    DNcoBR E.Danish National Commitee on Biomedical Research Ethics (2011) Guidelines about Notification. http://www.cvk.sum.dk/English/guidelinesaboutnotification.aspx. Accessed 21 Sept 2014
  18. 18.
    Kent P, Lauridsen HH (2011) Managing missing scores on the Roland Morris Disability Questionnaire. Spine (Phila Pa 1976) 36:1878–1884CrossRefGoogle Scholar
  19. 19.
    Grotle M, Foster NE, Dunn KM, Croft P (2010) Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? Pain 151:790–797CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Lars Morso
    • 1
    Email author
  • Alice Kongsted
    • 2
    • 3
  • Lise Hestbaek
    • 2
    • 3
  • Peter Kent
    • 3
  1. 1.Centre for Quality, Region of Southern DenmarkMiddelfartDenmark
  2. 2.Nordic Institute of Chiropractic and Clinical BiomechanicsOdenseDenmark
  3. 3.Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark

Personalised recommendations