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The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - A population based cohort study

Haglund, Emma LU ; Bremander, Ann LU and Bergman, Stefan LU (2019) In BMC Musculoskeletal Disorders 20(1).
Abstract

Background: The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods: One hundred and nineteen individuals (aged 40-71 years, mean (SD) 59 (8)... (More)

Background: The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods: One hundred and nineteen individuals (aged 40-71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin - as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0-18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Results: Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - < 0.001). Conclusions: Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic widespread pain, Low back pain, Multisite pain, Population-based cohort, Prognostic indicators, Questionnaire
in
BMC Musculoskeletal Disorders
volume
20
issue
1
article number
460
publisher
BioMed Central
external identifiers
  • scopus:85073725359
  • pmid:31638972
ISSN
1471-2474
DOI
10.1186/s12891-019-2836-1
language
English
LU publication?
yes
id
01e243c0-acf4-4b0a-ab0f-b2d565c79297
date added to LUP
2019-10-31 08:22:07
date last changed
2020-01-13 02:29:49
@article{01e243c0-acf4-4b0a-ab0f-b2d565c79297,
  abstract     = {<p>Background: The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. Methods: One hundred and nineteen individuals (aged 40-71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin - as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0-18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Results: Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 - &lt; 0.001). Conclusions: Both screening tools identified individuals at risk, but they captured different aspects, and also different number of individuals at high risk of a worse prognosis. Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT.</p>},
  author       = {Haglund, Emma and Bremander, Ann and Bergman, Stefan},
  issn         = {1471-2474},
  language     = {eng},
  month        = {10},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Musculoskeletal Disorders},
  title        = {The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - A population based cohort study},
  url          = {http://dx.doi.org/10.1186/s12891-019-2836-1},
  doi          = {10.1186/s12891-019-2836-1},
  volume       = {20},
  year         = {2019},
}