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Feasibility of the STarT back screening tool in chiropractic clinics: a cross-sectional study of patients with low back pain.

Kongsted A, Johannesen E, Leboeuf-Yde C - Chiropr Man Therap (2011)

Bottom Line: The SBT risk groups were positively associated with all of the psychological questionnaires.The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 - 6.3) for the MDI to 7.6 (95% CI 4.9 - 11.7) for the FABQ.If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Part of Clinical Locomotion Network, Denmark. a.kongsted@nikkb.dk.

ABSTRACT
The STarT back screening tool (SBT) allocates low back pain (LBP) patients into three risk groups and is intended to assist clinicians in their decisions about choice of treatment. The tool consists of domains from larger questionnaires that previously have been shown to be predictive of non-recovery from LBP. This study was performed to describe the distribution of depression, fear avoidance and catastrophising in relation to the SBT risk groups. A total of 475 primary care patients were included from 19 chiropractic clinics. They completed the SBT, the Major Depression Inventory (MDI), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Coping Strategies Questionnaire. Associations between the continuous scores of the psychological questionnaires and the SBT were tested by means of linear regression, and the diagnostic performance of the SBT in relation to the other questionnaires was described in terms of sensitivity, specificity and likelihood ratios.In this cohort 59% were in the SBT low risk, 29% in the medium risk and 11% in high risk group. The SBT risk groups were positively associated with all of the psychological questionnaires. The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 - 6.3) for the MDI to 7.6 (95% CI 4.9 - 11.7) for the FABQ. The SBT questionnaire was feasible to use in chiropractic practice and risk groups were related to the presence of well-established psychological prognostic factors. If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.

No MeSH data available.


Related in: MedlinePlus

The proportion of patients with high scores on depression, fear-avoidance or catastrophising within the three SBT risk groups in 475 chiropractic patients.
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Figure 2: The proportion of patients with high scores on depression, fear-avoidance or catastrophising within the three SBT risk groups in 475 chiropractic patients.

Mentions: The MDI was adequately completed by 471 patients. The scores ranged from 0 to 42 (median 9), and 10% had a score of > 24 indicating the possibility of at least a moderate depression. The continuous MDI scores were positively associated with the SBT risk groups showing a dose-response relation (Table 3). The proportions of patients with signs of depression increased from 5% in the low risk group to 31% in the high risk SBT group (Figure 2). The low risk group had a lower post-test risk of being depressed than the prior probability, whereas the posterior risk of the medium risk group did not differ from the risk of the entire population (Table 4). The high risk group had a high specificity for depression and an almost four times increased likelihood of depression, but the sensitivity was only 33% (Table 4).


Feasibility of the STarT back screening tool in chiropractic clinics: a cross-sectional study of patients with low back pain.

Kongsted A, Johannesen E, Leboeuf-Yde C - Chiropr Man Therap (2011)

The proportion of patients with high scores on depression, fear-avoidance or catastrophising within the three SBT risk groups in 475 chiropractic patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3105955&req=5

Figure 2: The proportion of patients with high scores on depression, fear-avoidance or catastrophising within the three SBT risk groups in 475 chiropractic patients.
Mentions: The MDI was adequately completed by 471 patients. The scores ranged from 0 to 42 (median 9), and 10% had a score of > 24 indicating the possibility of at least a moderate depression. The continuous MDI scores were positively associated with the SBT risk groups showing a dose-response relation (Table 3). The proportions of patients with signs of depression increased from 5% in the low risk group to 31% in the high risk SBT group (Figure 2). The low risk group had a lower post-test risk of being depressed than the prior probability, whereas the posterior risk of the medium risk group did not differ from the risk of the entire population (Table 4). The high risk group had a high specificity for depression and an almost four times increased likelihood of depression, but the sensitivity was only 33% (Table 4).

Bottom Line: The SBT risk groups were positively associated with all of the psychological questionnaires.The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 - 6.3) for the MDI to 7.6 (95% CI 4.9 - 11.7) for the FABQ.If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Part of Clinical Locomotion Network, Denmark. a.kongsted@nikkb.dk.

ABSTRACT
The STarT back screening tool (SBT) allocates low back pain (LBP) patients into three risk groups and is intended to assist clinicians in their decisions about choice of treatment. The tool consists of domains from larger questionnaires that previously have been shown to be predictive of non-recovery from LBP. This study was performed to describe the distribution of depression, fear avoidance and catastrophising in relation to the SBT risk groups. A total of 475 primary care patients were included from 19 chiropractic clinics. They completed the SBT, the Major Depression Inventory (MDI), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Coping Strategies Questionnaire. Associations between the continuous scores of the psychological questionnaires and the SBT were tested by means of linear regression, and the diagnostic performance of the SBT in relation to the other questionnaires was described in terms of sensitivity, specificity and likelihood ratios.In this cohort 59% were in the SBT low risk, 29% in the medium risk and 11% in high risk group. The SBT risk groups were positively associated with all of the psychological questionnaires. The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 - 6.3) for the MDI to 7.6 (95% CI 4.9 - 11.7) for the FABQ. The SBT questionnaire was feasible to use in chiropractic practice and risk groups were related to the presence of well-established psychological prognostic factors. If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.

No MeSH data available.


Related in: MedlinePlus