Adding information on multisite and widespread pain to the STarT back screening tool when identifying low back pain patients at risk of worse prognosis.

Abstract

Objectives: The STarT Back screening Tool (SBT) captures patients with low back pain (LBP) at risk of worse prognosis. However, the SBT does not include assessment of multisite and chronic widespread pain (MS-CWP). The aim was to study the differences in prognostic factors in patients with LBP classified according to SBT or SBT in combination with MS-CWP, and the 1-year outcome regarding visits to physiotherapist and sickness absence, in relation to risk scorings.

Methods: In this 1-year prospective study, adults (18-67 years) seeking care for LBP in primary care were classified into three prognostic risk groups (low, medium, high), using SBT only and using a combined screening tool (SBT and MS-CWP). Differences in prognostic factors at baseline, and outcome in terms of number of physiotherapist visits and sickness absence the year after inclusion were compared for risk groups derived by the two methods.

Results: Eighty-four patients (61% women) were included in the study. According to SBT alone, 19 were classified as low risk, 48 as medium risk, and 17 as high risk. When using the combined screening tool, additionally seven patients from the medium risk group were classified as high risk. Patients classified as high risk by SBT only or by the combined screening tool showed similar statistically significant worse mental health, health status, kinesiophobia, physical function, and sleep, as compared to the low-risk group. There were no differences in visits to physiotherapist and sickness absence between the risk groups for neither of the tools.

Conclusion: The combined screening tool resulted in more patients being classified as high risk than with SBT alone. The three risk groups identified either by SBT alone or by the combined screening tool differed significantly on all investigated prognostic factors, suggesting that including MS-CWP to the SBT captures more patients at risk.