The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis - a population based cohort study

• Published in: BMC musculoskeletal disorders 2019-10, Vol.20 (1), p.460-460, Article 460
• Main Authors: Haglund, Emma, Bremander, Ann, Bergman, Stefan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Back pain; Care and treatment; Case-Control Studies; Chronic widespread pain; classification; Clinical Medicine; cohort; Cohort analysis; Cohort Studies; Diagnosis; disability; fear-avoidance beliefs; Female; fibromyalgia; global burden; Health; Health screening; Humans; Klinisk medicin; Low back pain; Low Back Pain - diagnosis; Male; management; Manikins; Medical and Health Sciences; Medical tests; Medicin och hälsovetenskap; Middle Aged; Multisite pain; Orthopedics; Ortopedi; Population-based; Population-based cohort; prevalence; primary-care; Prognosis; Prognostic indicators; Questionnaire; Reumatologi och inflammation; Rheumatology; Rheumatology and Autoimmunity; Risk Assessment; Self Report; Triage - methods; widespread
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-019-2836-1

The STarT Back Screening Tool (SBT) identifies patients with low back pain (LBP) at risk of a worse prognosis of persistent disabling back pain, and thereby facilitates triage to appropriate treatment level. However, the SBT does not consider the pain distribution, which is a known predictor of chronic widespread pain (CWP). The aim of this study was to determine if screening by the SBT and screening of multisite chronic widespread pain (MS-CWP) could identity individuals with a worse prognosis. A secondary aim was to analyze self-reported health in individuals with and without LBP, in relation to the combination of these two screening tools. One hundred and nineteen individuals (aged 40-71 years, mean (SD) 59 (8) years), 52 with LBP and 67 references, answered two screening tools; the SBT and a pain mannequin - as well as a questionnaire addressing self-reported health. The SBT stratifies into low, medium or high risk of a worse prognosis. The pain mannequin stratifies into either presence or absence of CWP in combination with ≥7 painful areas of pain (0-18), here defined as MS-CWP (high risk of worse prognosis). The two screening tools were studied one-by-one, and as a combined screening. For statistical analyses, independent t-tests and Chi-square tests were used. Both the SBT and the pain mannequin identified risk of a worse prognosis in individuals with (p = 0.007) or without (p = 0.001) LBP. We found that the screening tools identified partly different individuals at risk. The SBT identified one individual, while the pain mannequin identified 21 (19%). When combining the two screening methods, 21 individuals (17%) were at high risk of a worse prognosis. When analyzing differences between individuals at high risk (combined SBT and MS-CWP) with those at low risk, individuals at high risk reported worse health (p = 0.013 -