title: The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings.
abstract: BACKGROUND
  Psychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted.
  
  
  OBJECTIVE
  The purpose of this study was to test the predictive validity of the STarT Back Screening Tool (SBT) in comparison with single-construct psychological measures for 6-month clinical outcomes.
  
  
  METHODS
  This was an observational, prospective cohort study.
  
  
  METHODS
  Patients (n=146) receiving physical therapy for low back pain were administered the SBT and a battery of psychological measures (Fear-Avoidance Beliefs Questionnaire physical activity scale and work scale [FABQ-PA and FABQ-W, respectively], Pain Catastrophizing Scale [PCS], 11-item version of the Tampa Scale of Kinesiophobia [TSK-11], and 9-item Patient Health Questionnaire [PHQ-9]) at initial evaluation and 4 weeks later. Treatment was at the physical therapist's discretion. Clinical outcomes consisted of pain intensity and self-reported disability. Prediction of 6-month clinical outcomes was assessed for intake SBT and psychological measure scores using multiple regression models while controlling for other prognostic variables. In addition, the predictive capabilities of intake to 4-week changes in SBT and psychological measure scores for 6-month clinical outcomes were assessed.
  
  
  RESULTS
  Intake pain intensity scores (β=.39 to .45) and disability scores (β=.47 to .60) were the strongest predictors in all final regression models, explaining 22% and 24% and 43% and 48% of the variance for the respective clinical outcome at 6 months. Neither SBT nor psychological measure scores improved prediction of 6-month pain intensity. The SBT overall scores (β=.22) and SBT psychosocial scores (β=.25) added to the prediction of disability at 6 months. Four-week changes in TSK-11 scores (β=-.18) were predictive of pain intensity at 6 months. Four-week changes in FABQ-PA scores (β=-.21), TSK-11 scores (β=-.20) and SBT overall scores (β=-.18) were predictive of disability at 6 months.
  
  
  CONCLUSIONS
  Physical therapy treatment was not standardized or accounted for in the analysis.
  
  
  CONCLUSIONS
  Prediction of clinical outcomes by psychology-based measures was dependent upon the clinical outcome domain of interest. Similar to studies from the primary care setting, initial screening with the SBT provided additional prognostic information for 6-month disability and changes in SBT overall scores may provide important clinical decision-making information for treatment monitoring.
authors.affiliation: Department of Physical Therapy, College of Public Health & Health Professions, University of Florida Health Science Center, Gainesville, FL 32610-0154, USA. beneciuk@phhp.ufl.edu
authors.forename: Jason M
authors.initials: JM
authors.lastname: Beneciuk
authors.forename: Mark D
authors.initials: MD
authors.lastname: Bishop
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
authors.forename: Nabih R
authors.initials: NR
authors.lastname: Asal
authors.forename: Anne N
authors.initials: AN
authors.lastname: Nisenzon
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D004185:Disability Evaluation; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D008297:Male; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome