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

Beneciuk, Jason M.; Fritz, Julie M.; George, Steven Z.

doi:10.2519/jospt.2014.5178

Cited by 42 publications

(25 citation statements)

References 32 publications

(49 reference statements)

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“…Participating physiotherapists in our study as well as others (Beneciuk et al, ; Beneciuk, Fritz, & George, ; Fritz, Beneciuk, & George, ) did not receive formal CBA training and did not follow recommended STarT‐targeted treatment pathways. Despite physiotherapists' lack of formal CBA education and training, significant improvements in FS scores at discharge from physiotherapy for high‐risk STarT patients with NSLBP have been consistently reported (Beneciuk et al, , ; Fritz et al, ). Participating therapists in these other studies were trained in a popular physiotherapy treatment‐based classification approach that included DP in its algorithm (Delitto et al, 1993).…”

Section: Discussionmentioning

confidence: 95%

Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT

Werneke¹,

Edmond

Young

et al. 2018

Physiotherapy Res Intl

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Section: Discussionmentioning

confidence: 95%

Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT

Werneke¹,

Edmond

Young

et al. 2018

Physiotherapy Res Intl

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“…The precise application of these risk models, and how they inform policy and practice should be the target of future study. However, physical therapy re-design might incorporate enhanced treatment monitoring to assess ongoing risk for downstream utilization, as well as physical therapist-led interventions to more thoroughly address important modifiable factors such as pain intensity, disability and pain-related psychological distress [ 38 ]. Improved pathway selection might entail the consideration of referral to or co-treatment with other providers to more adequately address non-modifiable characteristics.…”

Section: Discussionmentioning

confidence: 99%

“… Block 4: Baseline-to-4 week change in pain intensity, region-specific disability, and OSPRO-YF scores. Early changes in these variables may be associated with improved prediction of outcomes over baseline variables alone [ 38 ]. This approach modeled change in these variables as a measure of treatment response and allowed us to assess the relative value of treatment monitoring for the prediction of healthcare utilization outcomes.…”

Section: Methodsmentioning

confidence: 99%

Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain

Lentz

Beneciuk

George

2018

BMC Health Serv Res

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BackgroundIn the United States, value-based purchasing has created the need for healthcare systems to prospectively identify patients at risk for high healthcare utilization beyond a physical therapy episode for musculoskeletal pain. The purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode of physical therapy for musculoskeletal pain.MethodsThis study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) longitudinal cohort study that recruited individuals with a primary complaint of neck, low back, knee or shoulder pain in physical therapy (n = 440). Demographics, health-related information, review of systems, comorbidity and pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in pain intensity, disability, and pain-related psychological distress were measured as treatment response variables. At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models were developed for any subsequent care and service-specific utilization.ResultsSubsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain intensity, disability and pain-related psychological distress predicted specific service utilization.ConclusionIn those completing follow up measures, risk of additional pain-related healthcare utilization after physical therapy was best predicted by baseline characteristics and 4-week treatment response variables for pain intensity, disability and pain-related psychological distress. These findings suggest treatment monitoring of specific response variables could enhance identification of those at risk for future healthcare utilization in addition to baseline assessment. Further study is required to determine how specific characteristics of the clinical encounter influence future utilization.

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“…The results of Beneciuk et al support this perspective, as they specifically analyzed the relevance of the timing of the SBT and found that especially in acute high-risk patients, tool scores often change within a few weeks. They therefore suggest further research examining the potential of repeated measures in helping to improve the accuracy of prognostic assessment in this subgroup [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of the German version of the STarT-Back Tool (STarT-G): a cohort study with patients from primary care practices

Karstens

Krug

Hill

et al. 2015

BMC Musculoskelet Disord

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BackgroundCurrent research emphasizes the high prevalence and costs of low back pain (LBP). The STarT Back Tool was designed to support primary care decision making for treatment by helping to determine the treatment prognosis of patients with non-specific low back pain. The German version is the STarT-G. The cross-cultural translation of the tool followed a structured and widely accepted process but to date it was only partially validated with a small sample.The aim of the study was to test the psychometric properties construct validity, discriminative ability, internal consistency and test-retest-reliability of the STarT-G and to compare them with values given for the original English version.MethodsA consecutive cohort study with a two-week retest was conducted among patients with non-specific LBP, aged 18 to 60 years, from primary care practices. Questionnaires were collected before the first consultation, and two weeks later by post, using the following reference standards: the Roland and Morris disability questionnaire, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale and the Hospital Anxiety and Depression Scale. Psychometric properties examined included the tool’s discriminative abilities, whether the psychosocial subscale was one factor, internal consistency, item redundancy, test-retest reliability and floor and ceiling effects.ResultsThere were 228 patients recruited with a mean age of 42.2 (SD 11.0) years, and 53 % were female. The areas under the curve (AUC) for discriminative ability ranged from 0.70 (STarT-G Subscale - Pain Catastrophizing Scale; CI95 0.63, 0.78) to 0.77 (STarT-G Total - Composite reference standard, CI95 0.60, 0.94). Factor loadings ranged from 0.49 to 0.74. Cronbach’s alpha testing the internal consistency and redundancy for the total/subscale scores were α = 0.52/0.55 respectively. The STarT-G test-retest reliability Kappa values for the total/subscale scores were 0.67/0.68 respectively. No floor or ceiling effects were present.ConclusionsThe STarT-G shows acceptable psychometric properties although not in exact agreement with the original English version. The items previously regarded as a psychosocial subscale may be better seen as an index of different individual psychosocial constructs. The relevance of using the tool at the point of consultation should be further examined.

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

Cited by 42 publications

References 32 publications

Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT

Directional preference and functional outcomes among subjects classified at high psychosocial risk using STarT

Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain

Validation of the German version of the STarT-Back Tool (STarT-G): a cohort study with patients from primary care practices

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