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Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study.

Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M - BMC Musculoskelet Disord (2015)

Bottom Line: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05).The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups.Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada. Isabelle.Page1@uqtr.ca.

ABSTRACT

Background: Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated.

Methods: Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST.

Results: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

Conclusion: Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year.

Trial registration: Clinicaltrials.gov NCT02226692.

No MeSH data available.


Related in: MedlinePlus

Sensitivity and specificity for STarT Back Screening Tool (SBST) cut-offs. Sensitivity and specificity in the identification of participants presenting higher levels of disability (a), fear of movement (b), and pain (c) at 6- (T3) and 12-month (T4) follow-ups
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Fig5: Sensitivity and specificity for STarT Back Screening Tool (SBST) cut-offs. Sensitivity and specificity in the identification of participants presenting higher levels of disability (a), fear of movement (b), and pain (c) at 6- (T3) and 12-month (T4) follow-ups

Mentions: Since no significant AUC was found for physiologic measures, all other parameters including sensitivity, specificity and positive and negative likelihood ratios (LRs) were only calculated for different SBST cut-offs (see Fig. 5 for sensitivity and specificity values). The cut-off value of ≥ 4, which represents the proposed value to discriminate between low and medium/high risk groups of persistent disabling LBP [13], showed specificity values ranging between 72.1 and 78.1 % and sensitivity values ranging between 42.9 and 75.0 % regarding disability and pain at T3 and T4, and fear of movement at T3. Furthermore, positive and negative LRs for this cut-off were ≤ 2.96 and ≥ 0.35 respectively, depending on both the dichotomous outcomes and the period evaluated. These LRs classify the SBST as a “sometimes useful test” for identifying those presenting disability, pain or fear of movement at 6- and 12-month follow-ups.Fig. 5


Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study.

Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M - BMC Musculoskelet Disord (2015)

Sensitivity and specificity for STarT Back Screening Tool (SBST) cut-offs. Sensitivity and specificity in the identification of participants presenting higher levels of disability (a), fear of movement (b), and pain (c) at 6- (T3) and 12-month (T4) follow-ups
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4541753&req=5

Fig5: Sensitivity and specificity for STarT Back Screening Tool (SBST) cut-offs. Sensitivity and specificity in the identification of participants presenting higher levels of disability (a), fear of movement (b), and pain (c) at 6- (T3) and 12-month (T4) follow-ups
Mentions: Since no significant AUC was found for physiologic measures, all other parameters including sensitivity, specificity and positive and negative likelihood ratios (LRs) were only calculated for different SBST cut-offs (see Fig. 5 for sensitivity and specificity values). The cut-off value of ≥ 4, which represents the proposed value to discriminate between low and medium/high risk groups of persistent disabling LBP [13], showed specificity values ranging between 72.1 and 78.1 % and sensitivity values ranging between 42.9 and 75.0 % regarding disability and pain at T3 and T4, and fear of movement at T3. Furthermore, positive and negative LRs for this cut-off were ≤ 2.96 and ≥ 0.35 respectively, depending on both the dichotomous outcomes and the period evaluated. These LRs classify the SBST as a “sometimes useful test” for identifying those presenting disability, pain or fear of movement at 6- and 12-month follow-ups.Fig. 5

Bottom Line: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05).The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups.Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada. Isabelle.Page1@uqtr.ca.

ABSTRACT

Background: Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated.

Methods: Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST.

Results: The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (/τ/ = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05).

Conclusion: Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year.

Trial registration: Clinicaltrials.gov NCT02226692.

No MeSH data available.


Related in: MedlinePlus