Background Patients with low back pain (LBP) and neck pain (NP) are frequently seen in primary health care practice. Clinicians need to find brief, practical tools to help identify patients that are at risk for long-term pain and functional impairment. There is insufficient knowledge on how to best match individuals to different treatment options in primary care. The STarT Back Tool (SBT) is a short, validated screening questionnaire on physical and psychosocial risk factors for long-term LBP that is specifically designed to help guide clinicians in their task of sign-posting individuals to different levels of care. The SBT has not formerly been validated in Swedish for a primary care population with acute and sub-acute LBP and NP.
Objectives To investigate the concurrent validity of the Swedish version of the STarT Back Screening Tool (SBT) against the short version of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ).
Methods A population of patients with LBP and/or NP (n= 303) were identified as part of the recruitment of participants to the WorkUp project, a prospective pare-wise cluster randomised controlled trial in 35 primary health care in southern Sweden. All patients who applied for physiotherapy services through direct access with acute and sub-acute LBP and/or NP, aged 18-67 years, not on sick leave or been on sick leave in the last 60 days, were asked to complete a SBT and ÖMPSQ between January 2013 and January 2014. Correlations between the SBT and ÖMPSQ short were calculated using Spearman's rank correlations.
Results Complete SBT (9-items) and ÖMPSQ short (10-items) data was available for 303/321 (94%) patients (190 women, 113 men). Median age was 45 (range 20-66). In the LBP only population (n=117) 50.4% were females and 49.6% were males and in a mixed population (LBP+NP) (n=186) 70.4% were females and 29.6% were males.
The Spearman's rank correlation coefficients for the SBT total scores and psychosocial subscale scores with the ÖMPSQ scores for the whole population were 0.630 (p<0.01), and 0.611 (p<0.01), respectively.
For males, the correlation was somewhat higher both for SBT total scores and psychosocial subscale scores (0.676 (p<0.01), sub-score 0.651 (p<0.01)) than for females (0.604 (p<0.01), sub-score 0.587 (p<0.01)) and the same was valid for patients <45 years (0.669 (p<0.01), sub-score 0.656 (p<0.01)) than for patients ≥45 years (0.589 (p<0.01), sub-score 0.571 (p<0.01)). In the LBP only group the SBT total scores and psychosocial subscale scores were 0.646 (p<0.01) and 0.619 (p<0.01), and for the mixed group it was 0.618 (p<0.01) and 0.604 (p<0.01), respectively.
Conclusions In this study, the correlations of SBT and ÖMPSQ short scores were moderate. Thus, SBT and ÖMPSQ short are comparable and indicate that SBT may be useful in primary care for individuals with acute or sub-acute neck and/or back pain. Further validation testing is required particularly regarding differences in the tool's subgroup classifications.
Hill JC, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet, 2011.378(9802):p.1560-71.
Linton SJ, et al. Spine, 2011.
Disclosure of Interest None declared