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

Abstract

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.

Association of STarT Back Tool and the short form of the Örebro Musculoskeletal Pain Screening Questionnaire with multidimensional risk factors

“…Similar results with respect to fear of movement have been observed in later cross-cultural validation studies of SBT [29][30][31][32] . SBT total and/or psychosocial subscale scores have shown to be associated with LBP-related disability, bothersomeness, catastrophizing, and depression/ depressive symptoms 5,13,[29][30][31][32][33][34][35] . Emotional and behavioural problems were strongly associated with multisite musculoskeletal pains in an earlier population-based study 36 .…”

Reliability and screening ability of the StarT Back screening tool in patients with low back pain in physiotherapy practice, a cohort study

“…The difference in pain and activity limitations between the low and the medium risk groups supports the suggestions that the groups should be offered different treatment. No participants were allocated into the high risk group in this study, in contrast to what has been reported previously [19, 28, 29]. The reason for this may be that our participants were recruited from patients treated by physiotherapists (PT) in primary health care, while others have recruited patients from general practices (GP) [29] and from both GP and PT [30].…”

Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care

“…has generated great interest in developed countries, providing new hope that meaningful improvements in primary care for LBP are within reach. [14][15][16][17][18][19] Prior to widespread implementation, it would be valuable to know if the STarT Back strategy can be successfully translated to other settings. To determine if the STarT Back risk stratification strategy would succeed in the USA, we conducted the Matching Appropriate Treatments to Consumer Healthcare needs (MATCH) cluster randomized trial.…”