Preliminary evaluation of a modified STarT back screening tool across different musculoskeletal pain conditions

Abstract

Background. The STarT Back Screening Tool is a validated multidimensional screening measure and risk stratification tool for people with low back pain. Objective. The study objective was to compare relationships between a modified STarT Back Screening Tool (mSBT) and clinical and psychological measures in people with low back, neck, shoulder, and knee pain. The hypothesis was that the relationships between mSBT scores and clinical and psychological measure scores would be similar across the included musculoskeletal pain conditions. Design. A cross-sectional, secondary analysis was done in this study. Methods. Participants with low back (n = 118), neck (n = 92), shoulder (n = 106), or knee (n = 111) pain were recruited, and an mSBT was developed for use across the pain conditions. Separate hierarchical linear regression models were developed, with clinical (health status, pain intensity, and disability) and psychological (kinesiophobia, catastrophizing, fear avoidance, anxiety, depressive symptoms, and self-efficacy) measures as dependent variables. Demographic and pain region variables were entered in the first step, mSBT scores were entered in the second step, and pain region × mSBT interactions were entered in the last step. Results. In the final models, no interactions were identified, suggesting that dependent measure scores did not differ by pain region. The strongest contributor for all dependent variables was mSBT scores (β = |0.32|-|0.68|); higher mSBT scores were associated with poorer health status and self-efficacy and with higher levels of pain intensity, disability, kinesiophobia, catastrophizing, fear avoidance, anxiety, and depressive symptoms. Limitations. Generalizability was restricted to physical therapy outpatients with the included pain conditions. The mSBT used in this study is not ready for clinical implementation. Conclusions. The results of this study support the feasibility of using a single measure for concise risk assessment across different musculoskeletal pain conditions. Further longitudinal studies are needed to better direct the clinical use of an mSBT in people with low back, neck, shoulder, and knee pain.