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  1. Katarina Aili1,2,3,
  2. Stefan Bergman3,4,
  3. Emma Haglund3,5
  1. 1Halmstad University, Halmstad School of Health and Welfare, Halmstad, Sweden
  2. 2Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
  3. 3RandD Spenshult, Halmstad, Sweden
  4. 4Institute of Medicine, The Sahlgrenska Academy, Primary Health Care Unit, Department of Public Health and Community Medicine, Gothenburg, Sweden
  5. 5Halmstad University, School of Business, Engineering and Science, Halmstad, Sweden


Background: Early identification of those with the highest risk of developing chronic low back pain (CLBP) is important but difficult. STarT Back Screening Tool (SBST) is reported to capture patients at high risk of developing CLBP, but does not include concurrent pain from other locations, which is a known risk factor for worse outcome.

Objectives: To study differences in self-reported health between patients with low, medium and high risk of developing CLBP identified by the combination of SBST and information on widespread pain.

Methods: Adults aged 18-67 seeking primary care for LBP in the southwest of Sweden were included. The STSB was used to differentiate between three risk levels; low, medium and high risk. When patients were classified as medium risk, information from a pain mannequin on widespread pain and multisite pain were added to further distinguish between high and medium risk. If widespread pain and pain from more than seven locations (multisite pain) were reported, patient was transformed from the medium risk to the high risk group. Differences between the three risk groups with regard to physical function (Roland Morrison Disability Questionnaire (RMDQ), 0-24 best-worst), mental health (Hospital Anxiety and Depression scale (HADa and HADd) 0-21 no distress-maximum distress), health related quality of life (EuroQol-5D (EQ5D), 0-1 worst-best), fear avoidance for physical activity (PA) and work (Fear-Avoidance Beliefs Questionnaire (FABQ) PA, 0-24, and work, 0-42 best-worst) were analyzed in an ANOVA.

Results: Ninety-five patients (61% women), mean (SD) age 42 years (14) seeking health-care for their LBP were included in the study. Of those scoring low risk on SBST (n=19), 3 also reported multisite CWP. Of those who scored medium risk on SBST (n=48), 8 reported multisite CWP and were moved to the high risk group. Of 17 scoring high risk on SBST, 4 simultaneously reported multisite CWP. After constructing three risk groups combining SBST and multisite CWP, there were 19 in the low risk group, 40 in the medium risk group, and 25 in the high-risk group. The low, medium, high risk groups identified by the combined method, differed statistically significant in reported RMDQ (low, medium, high mean respectively 7.0, 12.2, 13.4, p<0.001), HADa (3.7, 6.4, 10.1, p<0.001), HADd (2.9, 4.0, 8.4, p<0.001), FABQ PA (9.1, 12.7, 14.4, p=0.005), FABQ work (9.9, 16.7, 23.1 p=0.001), EQ5D (0.72, 0.53, 0.38, p=0.001).

Conclusion: Adding information on multisite widespread pain to the SBST resulted in classifying more patients in the high risk group as compared to using only SBST. The three groups identified by combing the screening tools differed significantly on all investigated health variables, indicating the combination may be capturing more patients at risk for CLBP.

Disclosure of Interests: None declared

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