Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting.
Pradeep Suri, Kristin Delaney, Sean D Rundell and 1 others
PMID 29625095WHAT IT FOUND
The STarT Back tool sorted U.S. primary care back pain patients into low, medium and high risk groups that predicted persistent disabling back pain at 6 months: 22%, 62% and 80% had it.
Key findings
01STarT Back risk groups were significantly associated with persistent disabling back pain at 6-month follow-up, with 22% of low-risk, 62% of medium-risk and 80% of high-risk participants affected.
02The tool's ability to separate patients who did and did not have persistent disabling back pain was very similar to the original STarT Back validation study.
03In older adults and in people with acute back pain, medium and high risk groups had similar persistent disabling back pain rates at 6 months (71% vs 79%, p=.17; 51% vs 55%, p=0.71).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The analysis came from one integrated health system in the Pacific Northwest, so the results may not apply to other U.S. clinics. The tool was tested only as three risk groups, not as a continuous score, and only with one outcome cutoff, a Roland-Morris score of 7 or higher. For older adults and people with acute back pain, the medium and high risk groups had similar persistent disabling pain rates, so the tool did not clearly separate those two groups in those patients. Comparisons with prior studies were descriptive, not individual-level hypothesis tests. This was a validation analysis, not a test of whether treatments matched to risk groups improve outcomes.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not conclude that using STarT Back to match treatment improves outcomes. This study tested whether baseline risk groups predicted persistent disabling back pain at 6 months; it did not test whether the full STarT Back approach with matched treatment works.