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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
Halmstad University, School of Business, Engineering and Science, The Rydberg Laboratory for Applied Sciences (RLAS). Spenshult Research and Development Center, Halmstad, Sweden.ORCID iD: 0000-0002-1445-5247
Spenshult Research and Development Center, Halmstad, Sweden & Section of Rheumatology, Lund University, Lund, Sweden & University of Southern Denmark, Odense, Denmark & University Hospital of Southern Denmark, Sønderborg, Denmark.ORCID iD: 0000-0002-8081-579X
Spenshult Research and Development Center, Halmstad, Sweden & Section of Rheumatology, Lund University, Lund, Sweden & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID iD: 0000-0002-6294-538X
2019 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, no 1, article id 460Article in journal (Refereed) Published
Abstract [en]

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. 

© The Author(s). 2019

Place, publisher, year, edition, pages
London: BioMed Central, 2019. Vol. 20, no 1, article id 460
Keywords [en]
Chronic widespread pain, Low back pain, Multisite pain, Population-based cohort, Prognostic indicators, Questionnaire
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:hh:diva-41221DOI: 10.1186/s12891-019-2836-1ISI: 000491317600003PubMedID: 31638972Scopus ID: 2-s2.0-85073725359OAI: oai:DiVA.org:hh-41221DiVA, id: diva2:1377014
Funder
AFA Insurance
Note

Funding: Swedish Rheumatism Association and Region Halland, Sweden 

Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2019-12-11Bibliographically approved

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