Predictive validity of the STarT Back screening tool among older adults with back pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-05-16 DOI:10.1002/ejp.2281

Ørjan Nesse Vigdal, Solveig Flugstad, Kjersti Storheim, Rikke Munk Killingmo, Margreth Grotle

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Abstract

Background

The predictive validity of the STarT Back screening tool among older adults is uncertain. This study aimed to assess the predictive validity of the SBT among older adults in primary care.

Methods

This prospective cohort study included 452 patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain. A poor outcome (persistent disabling back pain) was defined as a score of ≥7/24 on the Roland-Morris Disability Questionnaire (RMDQ) at 3, 6 or 12 months of follow-up. The ability of the SBT risk groups to identify persistent disabling back pain was assessed with multivariable logistic regression, area under receiver operating characteristics curve (AUC), and with the accuracy measures sensitivity, specificity, predictive values and likelihood ratios.

Results

The adjusted odds ratios (95% CI) for persistent disabling back pain were 2.40 (1.34–4.30) at 3 months, 3.42 (1.76–6.67) at 6 months and 2.81 (1.47–5.38) at 12 months for the medium-risk group (n = 118), and 8.90 (1.83–43.24), 2.66 (0.81–8.67) and 4.53 (1.24–16.46) for the high-risk group (n = 27), compared to the low-risk group (n = 282). There were no statistically significant differences in odds between the medium- and high-risk groups at any time point. AUC values (95% CI) were 0.65 (0.59–0.71), 0.67 (0.60–0.73) and 0.65 (0.58–0.71) at 3, 6 and 12 months. Accuracy measures were poor at all time points, with particularly poor sensitivity and negative likelihood ratio values.

Conclusion

The predictive validity of the SBT risk groups in predicting persistent disabling back pain in older adults was poor.

Significance Statement

This study found that the STarT Back screening tool had poor predictive validity among older adults and that it may need recalibration or extension before widespread implementation among older adults. Having valid tools for this population may aid clinicians with allocating scarce healthcare resources, which is especially important considering the rapidly ageing population and its expected challenge to the healthcare systems.

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STarT 背痛筛查工具在患有背痛的老年人中的预测有效性。

背景：STarT背部筛查工具在老年人中的预测有效性尚不确定。本研究旨在评估 SBT 在初级保健中老年人中的预测有效性：这项前瞻性队列研究纳入了 452 名年龄≥55 岁、因新发背痛而到挪威初级保健机构就诊的患者。随访3、6或12个月时，罗兰-莫里斯残疾问卷（RMDQ）得分≥7/24，即为不良结局（持续性致残性背痛）。通过多变量逻辑回归、接收器工作特征曲线下面积（AUC）以及敏感性、特异性、预测值和似然比等准确性指标，评估了 SBT 风险组识别持续性致残背痛的能力：持续性失能背痛的调整后几率（95% CI）分别为：3 个月时 2.40（1.34-4.30），6 个月时 3.42（1.76-6.67），12 个月时 2.81（1.47-5.38）。与低风险组（n = 282）相比，中风险组（n = 118）在 12 个月时的腰痛程度分别为 8.90（1.83-43.24）、2.66（0.81-8.67）和 4.53（1.24-16.46）。中风险组和高风险组在任何时间点的几率差异均无统计学意义。3、6和12个月时的AUC值（95% CI）分别为0.65（0.59-0.71）、0.67（0.60-0.73）和0.65（0.58-0.71）。所有时间点的准确性都较差，灵敏度和负似然比值尤其低：结论：SBT 风险组在预测老年人持续性致残背痛方面的预测有效性较差：本研究发现，STarT Back 筛选工具在老年人中的预测有效性较差，可能需要重新校准或扩展后才能在老年人中广泛使用。考虑到人口快速老龄化及其对医疗保健系统的预期挑战，这一点尤为重要。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.