Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?
BACKGROUND
The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP.


METHODS
In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios.


RESULTS
The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1.


CONCLUSIONS
A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs.
Department of Family Medicine, University of California San Francisco, USA; Osher Center for Integrative Medicine, University of California San Francisco, USA.
W E
WE
Mehling
A L
AL
Avins
M C
MC
Acree
T S
TS
Carey
F M
FM
Hecht
D059787:Acute Pain / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D059350:Chronic Pain / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment