Abstract
Objective
To examine the predictive validity of the Subgrouping for Targeted Treatment (STarT
Back) tool for classifying people with back pain into categories of low, medium, and
high risk of persistent disabling back pain in U.S. primary care.
Design
Secondary analysis of data from participants receiving usual care in a randomized
clinical trial.
Setting
Primary care clinics.
Participants
Adults (N = 1109) ≥18 years of age with back pain. Those with specific causes of back
pain (pregnancy, disc herniation, vertebral fracture, spinal stenosis) and work-related
injuries were not included.
Interventions
Not applicable.
Main Outcome Measures
The original 9-item version of the STarT Back tool, administered at baseline, stratified
patients by their risk (low, medium, high) of persistent disabling back pain (STarT
Back risk group). Persistent disabling back pain was defined as Roland-Morris Disability
Questionnaire scores of ≥7 at 6-month follow-up.
Results
The STarT Back risk group was a significant predictor of persistent disabling back
pain (P<.0001) at 6-month follow-up. The proportion of individuals with persistent disabling
back pain at follow-up was 22% (95% confidence interval [CI] 18-25) in the low-risk
group, 62% (95% CI 57-67) in the medium-risk group, and 80% (95% CI 75-85) in the
high-risk group. The relative risk of persistent disabling back pain was 2.9 (95%
CI 2.4-3.5) in the medium-risk group compared to the low-risk group, and 3.7 (95%
CI 3.1-4.4) in the high-risk group.
Conclusions
The STarT Back risk groups successfully separated people with back pain into distinct
categories of risk for persistent disabling back pain at 6-month follow-up in U.S.
primary care. These results were very similar to those in the original STarT Back
validation study. This validation study is a necessary first step toward identifying
whether the entire STarT Back approach, including matched/targeted treatment, can
be effectively used for primary care in the United States.
Keywords
List of abbreviations:
CI (confidence interval), EHR (electronic health record), MATCH (Matching Appropriate Treatments to Consumers’ Healthcare Needs study), NRS (numeric pain rating scale), RMDQ (Roland-Morris Disability Questionnaire), RR (relative risk), STarT Back (Subgrouping for Targeted Treatment tool), U.K. (United Kingdom), U.S. (United States)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 03, 2018
Footnotes
Drs. Cherkin and Delaney report funding for this research provided by the Patient Centered Care Research Institute (Evaluation of a Patient-Centered Risk Stratification Method for Improving Primary Care for Back Pain; contract no. 398) and by the National Center for Complementary and Integrative Health/National Institutes of Health (Implementing Evidence-Based Treatments for Persistent Back Pain into Primary Care; grant no. R21AT0007326). Dr. Suri is employed by the VA Puget Sound Health Care System. Dr. Suri is funded by a Career Development Award (no. 1IK2RX001515) from VA Rehabilitation Research and Development. The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the Veterans Administration, Patient-Centered Outcomes Research Institute, the National Institutes of Health, or a U.S. government agency. None of the agencies that funded the study had any input into the design, conduct, data collection, analysis or interpretation, reporting, or writing of this article.
Clinical Trial Registration No. National Clinical Trial Number NCT02286141.
The authors report no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
