A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol

Abstract

Background: Back pain is a major health problem and many sufferers develop persistent symptoms. Detecting relevant subgroups of patients with non-specific low back pain has been highlighted as a priority area for research, as this could enable better secondary prevention through the targeting of prognostic indicators for persistent, disabling symptoms. We plan to conduct a randomised controlled trial to establish whether subgrouping using a novel tool, combined with targeted treatment, is better than best current care at reducing long-term disability from low back pain.

Relationship Between Categorization With the STarT Back Screening Tool and Prognosis for People Receiving Physical Therapy for Low Back Pain

“…13 The developers of the SBT propose that patients in the low-risk group, with few negative prognostic factors, have a good prognosis and likely should not be referred to physical therapists. The medium-risk category indicates a less-favorable prognosis because of the presence of primarily physical factors, and patients in this group are proposed to be most appropriate for referral to physical therapists.…”

“…The high-risk category includes patients with an unfavorable prognosis because of psychosocial factors, and these patients are presumed to require additional care to address both physical and psychosocial factors. 13 Patients in the high-risk category are proposed to be most likely to benefit from referral for treatment encompassing strategies to address both physical and psychosocial factors, which may require referral to physical therapists who have additional training or are working in a multidisciplinary setting. 12,13 Because of the nature of the present study, we could not directly examine the validity of a targeted treatment approach based on the SBT.…”

“…The SBT categorizes patients as being at high risk (the presence of high levels of psychosocial prognostic factors, with or without the presence of physical factors), medium risk (the presence of physical and psychosocial prognostic factors, but not a high level of psychosocial factors), or low risk (the presence of few physical and psychosocial prognostic factors). 13 The SBT has been shown to have concurrent validity with a similar screening tool 14 and has been validated as predictive of future disability for patients with LBP within a primary care setting. 12 The SBT was developed in a primary care physician setting and thus far has been examined only in that context.…”

The STarT Back Screening Tool for Prediction of 6-Month Clinical Outcomes: Relevance of Change Patterns in Outpatient Physical Therapy Settings

“…Based on overall and psychosocial subscale scoring, the SBT categorizes patients as high risk (psychosocial subscale scores of 4 or greater), in which high levels of psychosocial prognostic factors are present, with or without physical factors present; medium risk (overall score greater than 3, psychosocial subscale score less than 4), in which physical and psychosocial factors are present, but not a high level of psychosocial factors; or low risk (overall score, 0-3), in which few prognostic factors are present. 13 Test-retest reliability values for SBT overall and psychosocial scale scores have been reported to be 0.79 and 0.76, respectively, 16 indicating substantial reliability. The SBT has also been reported to demonstrate a high level of concurrent validity when compared to the Örebro Musculoskeletal Pain Screening Questionnaire.…”

Prevalência da dor lombar no Brasil: uma revisão sistemática

“…This condition imposes a high cost on the society, especially in developed countries 10,11,12 . Various studies 13,14,15,16,17,18,19 in recent years have attempted to understand more about low back pain and how to manage it. However, precise estimates of low back pain prevalence are necessary to elucidate the developmental perspective of low back pain in different countries 20 .…”