Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort studyReportar como inadecuado

Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Musculoskeletal Disorders

, 16:201

First Online: 19 August 2015Received: 11 May 2015Accepted: 10 August 2015


BackgroundStratification strategies based on identifying patient’s prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool SBST although promising, has not been studied in patients with chronic low back pain cLBP. Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient’s global impression of change was also investigated.

MethodsFifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks and the SBST were assessed at baseline. Disability Oswestry Disability Index, ODI, pain intensity 101-point Numerical Rating Scale, NRS, fear of movement Tampa Scale for Kinesiophobia, TSK and patient’s global impression of change 7-point scale, PGIC were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST.

ResultsThe SBST allowed for the identification of participants presenting higher levels of disability ODI ≥24 %, pain NRS ≥37 % or fear of movement TSK ≥41-68 over a 12-month period AUC = 0.71 to 0.84, ps < 0.05. The SBST score was also correlated with disability at each follow-up τ = 0.22 to 0.33, ps < 0.05 and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up |τ| = 0.26 to 0.32, ps < 0.05 and none was able to identify participants presenting higher levels of outcomes AUC ps > 0.05.

ConclusionPhysiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year.

Trial NCT02226692

AbbreviationsAUCArea under ROC curve


LBPLow back pain

LRLikelihood ratio

MFMedian frequency

MFslopeMF slope

MVCMaximal isometric voluntary contraction

NMFslopeNormalized MFslope

NRSNumerical rating scale

ODIOswestry disability index

PGICPatient’s global impression of change scale

RMDQRoland Morris disability questionnaire

RMSRoot mean square

ROCReceiver operating characteristic

SBSTSubgroup for targeted Treatment STarT Back Screening Tool

T0Baseline assessment

T1 to T42-, 4-, 6- and 12-month follow-up assessments

TSKTampa Scale for Kinesiophobia

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Autor: Isabelle Pagé - Jacques Abboud - Julie O᾽Shaughnessy - Louis Laurencelle - Martin Descarreaux


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