Beneciuk Jason M, Robinson Michael E, George Steven Z
Department of Physical Therapy, University of Florida, Gainesville, Florida; Brooks Rehabilitation-University of Florida College of Public Health and Health Professions Research Collaboration, Jacksonville, Florida.
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, Florida.
J Pain. 2015 Jan;16(1):19-30. doi: 10.1016/j.jpain.2014.10.004. Epub 2014 Oct 22.
Early screening for psychological distress has been suggested to improve patient management for individuals experiencing low back pain. This study compared 2 approaches to psychological screening (ie, multidimensional and unidimensional) so that preliminary recommendations on which approach may be appropriate for use in clinical settings other than primary care could be provided. Specifically, this study investigated aspects of the STarT Back Screening Tool (SBT): 1) discriminant validity by evaluating its relationship with unidimensional psychological measures and 2) construct validity by evaluating how SBT risk categories compared to empirically derived subgroups using unidimensional psychological and disability measures. Patients (N = 146) receiving physical therapy for LBP were administered the SBT and a battery of unidimensional psychological measures at initial evaluation. Clinical measures consisted of pain intensity and self-reported disability. Several SBT risk-dependent relationships (ie, SBT low < medium < high risk) were identified for unidimensional psychological measure scores, with depressive symptom scores associated with the strongest influence on SBT risk categorization. Empirically derived subgroups indicated that there was no evidence of distinctive patterns among psychological or disability measures other than high or low profiles; therefore, 2 groups may provide a clearer representation of the level of pain-associated psychological distress, maladaptive coping, and disability in this setting compared with 3 groups as suggested when using the SBT in primary care settings.
This study suggests that the SBT can replace administering several unidimensional psychological measures as a first-line screening measure for psychological distress. However, clinicians need to be aware of the potential for misclassification with SBT results when compared to unidimensional measures. This study also suggests that a modified SBT risk stratification scheme based on empirically derived subgroups could potentially assist in identifying elevated levels of pain-associated psychological distress, maladaptive coping, and disability in practice settings outside of primary care. Patients identified with elevated levels of pain-associated distress and maladaptive coping may be indicated for additional assessment using construct-specific questionnaires.
有人建议对心理困扰进行早期筛查，以改善对腰痛患者的管理。本研究比较了两种心理筛查方法（即多维和单维），以便就哪种方法可能适用于初级保健以外的临床环境提供初步建议。具体而言，本研究调查了STarT Back筛查工具（SBT）的以下方面：1）通过评估其与单维心理测量指标的关系来检验区分效度，以及2）通过使用单维心理和残疾测量指标评估SBT风险类别与根据经验得出的亚组的比较情况来检验结构效度。接受腰痛物理治疗的患者（N = 146）在初始评估时接受了SBT和一系列单维心理测量指标的测试。临床测量指标包括疼痛强度和自我报告的残疾情况。在单维心理测量指标得分方面，确定了几种SBT风险依赖关系（即SBT低风险<中风险<高风险），其中抑郁症状得分对SBT风险分类的影响最大。根据经验得出的亚组表明，除了高或低特征外，在心理或残疾测量指标中没有明显模式的证据；因此，与在初级保健环境中使用SBT时建议的三组相比，两组可能更清楚地反映了这种情况下与疼痛相关的心理困扰、适应不良应对和残疾水平。
本研究表明，SBT可以替代多项单维心理测量指标，作为心理困扰的一线筛查措施。然而，临床医生需要意识到，与单维测量指标相比，SBT结果存在错误分类的可能性。本研究还表明，基于经验得出的亚组的改良SBT风险分层方案可能有助于在初级保健以外的实践环境中识别与疼痛相关的心理困扰、适应不良应对和残疾的升高水平。被确定为与疼痛相关困扰和适应不良应对水平升高的患者可能需要使用特定结构的问卷进行额外评估。
