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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Risk classification of patients referred to secondary care for low back pain

Authors: Monica Unsgaard-Tøndel, Ingunn Gunnes Kregnes, Tom I. L. Nilsen, Gunn Hege Marchand, Torunn Askim

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories.

Methods

An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen’s Kappa coefficient, Pearson’s r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool.

Results

A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ.

Conclusion

The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.
Literature
1.
Hoy DG, Smith E, Cross M, Sanchez-Riera L, Blyth FM, Buchbinder R, Woolf AD, Driscoll T, Brooks P, March LM. Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the global burden of disease 2010 study and the next steps forward. Ann Rheum Dis. 2015;74(1):4–7.CrossRefPubMed
2.
March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, Buchbinder R, Vos T, Woolf AD. Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol. 2014;28(3):353–66.CrossRefPubMed
3.
Srinivas SV, Deyo RA, Berger ZD. Application of "less is more" to low back pain. Arch Intern Med. 2012;172(13):1016–20.CrossRefPubMed
4.
Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94.CrossRefPubMedPubMedCentral
5.
Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748.CrossRefPubMed
6.
van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A, Care CBWGoGftMoALBPiP. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169–91.CrossRefPubMed
7.
Christensen J, Fisker A, Mortensen EL, Olsen LR, Mortensen OS, Hartvigsen J, Langberg H. Comparison of mental distress in patients with low back pain and a population-based control group measured by symptoms check list--a case-referent study. Scand J Public Health. 2015;43(6):638–47.CrossRefPubMed
8.
O'Sullivan P, Caneiro JP, O'Keeffe M, O'Sullivan K. Unraveling the complexity of low back pain. J Orthop Sports Phys Ther. 2016;46(11):932–7.CrossRefPubMed
9.
Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, Hay EM. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–41.CrossRefPubMed
10.
Bruyere O, Demoulin M, Beaudart C, Hill JC, Maquet D, Genevay S, Mahieu G, Reginster JY, Crielaard JM, Demoulin C. Validity and reliability of the French version of the STarT back screening tool for patients with low back pain. Spine (Phila Pa 1976). 2014;39(2):E123–8.CrossRef
11.
Morso L, Albert H, Kent P, Manniche C, Hill J. Translation and discriminative validation of the STarT back screening tool into Danish. Eur Spine J. 2011;20(12):2166–73.CrossRefPubMedPubMedCentral
12.
Morso L, Kent P, Albert HB, Hill JC, Kongsted A, Manniche C. The predictive and external validity of the STarT back tool in Danish primary care. Eur Spine J. 2013;22(8):1859–67.CrossRefPubMedPubMedCentral
13.
Piironen S, Paananen M, Haapea M, Hupli M, Zitting P, Ryynanen K, Takala EP, Korniloff K, Hill JC, Hakkinen A, et al. Transcultural adaption and psychometric properties of the STarT back screening tool among Finnish low back pain patients. Eur Spine J. 2016;25(1):287–95.CrossRefPubMed
14.
Luan S, Min Y, Li G, Lin C, Li X, Wu S, Ma C, Hill JC. Cross-cultural adaptation, reliability, and validity of the Chinese version of the STarT back screening tool in patients with low back pain. Spine (Phila Pa 1976). 2014;39(16):E974–9.CrossRef
15.
Karstens S, Krug K, Hill JC, Stock C, Steinhaeuser J, Szecsenyi J, Joos S. Validation of the German version of the STarT-back tool (STarT-G): a cohort study with patients from primary care practices. BMC Musculoskelet Disord. 2015;16:346.CrossRefPubMedPubMedCentral
16.
Robinson HS, Dagfinrud H. Reliability and screening ability of the StarT back screening tool in patients with low back pain in physiotherapy practice, a cohort study. BMC Musculoskelet Disord. 2017;18(1):232.CrossRefPubMedPubMedCentral
17.
Forsbrand M, Grahn B, Hill JC, Petersson IF, Sennehed CP, Stigmar K. Comparison of the Swedish STarT back screening tool and the short form of the Orebro musculoskeletal pain screening questionnaire in patients with acute or subacute back and neck pain. BMC Musculoskelet Disord. 2017;18(1):89.CrossRefPubMedPubMedCentral
18.
Linton SJ, Boersma K. Early identification of patients at risk of developing a persistent back problem: the predictive validity of the Orebro musculoskeletal pain questionnaire. Clin J Pain. 2003;19(2):80–6.CrossRefPubMed
19.
Hill JC, Dunn KM, Main CJ, Hay EM. Subgrouping low back pain: a comparison of the STarT back tool with the Orebro musculoskeletal pain screening questionnaire. Eur J Pain. 2010;14(1):83–9.CrossRefPubMedPubMedCentral
20.
Linton SJ, Hallden K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998;14(3):209–15.CrossRefPubMed
21.
Maher CG, Grotle M. Evaluation of the predictive validity of the Orebro musculoskeletal pain screening questionnaire. Clin J Pain. 2009;25(8):666–70.CrossRefPubMed
22.
Hockings RL, McAuley JH, Maher CG. A systematic review of the predictive ability of the Orebro musculoskeletal pain questionnaire. Spine (Phila Pa 1976). 2008;33(15):E494–500.CrossRef
23.
Ruokolainen O, Haapea M, Linton S, Korniloff K, Hakkinen A, Paananen M, Karppinen J. Construct validity and reliability of Finnish version of Orebro musculoskeletal pain screening questionnaire. Scand J Pain. 2016;13:148–53.PubMedCrossRef
24.
Soer R, Vroomen P, Stewart R, Coppes M, Stegeman P, Dijkstra P, Reneman M. Factor analyses for the Orebro musculoskeletal pain questionnaire for working and nonworking patients with chronic low back pain. Spine J. 2017;17(4):603–9.CrossRefPubMed
25.
Andresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil. 2000;81(12 Suppl 2):S15–20.CrossRefPubMed
26.
Fuhro FF, Fagundes FR, Manzoni AC, Costa LO, Cabral CM. Orebro musculoskeletal pain screening questionnaire - short form and Start back screening tool: correlation and agreement analysis. Spine (Phila Pa 1976). 2016;41(15):E931–6.CrossRef
27.
Soegaard R, Christensen FB, Christiansen T, Bunger C. Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J. 2007;16(5):657–68.CrossRefPubMed
28.
Pedersen P, Nielsen CV, Jensen OK, Jensen C, Labriola M. Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain. Scand J Public Health. 2018;46(3):383–8.CrossRefPubMed
29.
Karran EL, Traeger AC, McAuley JH, Hillier SL, Yau YH, Moseley GL. The value of prognostic screening for patients with low back pain in secondary care. J Pain. 2017;18(6):673–86.CrossRefPubMed
30.
Morso L, Kent P, Manniche C, Albert HB. The predictive ability of the STarT back screening tool in a Danish secondary care setting. Eur Spine J. 2014;23(1):120–8.CrossRefPubMed
Metadata
Title
Risk classification of patients referred to secondary care for low back pain
Authors
Monica Unsgaard-Tøndel
Ingunn Gunnes Kregnes
Tom I. L. Nilsen
Gunn Hege Marchand
Torunn Askim
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2082-y

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