Butera Katie A, Lentz Trevor A, Beneciuk Jason M, George Steven Z
K.A. Butera, PT, DPT, Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610-0154 (USA), and Brooks-PHHP Research Collaboration, University of Florida, Gainesville, Florida.
T.A. Lentz, PT, SCS, Department of Physical Therapy, University of Florida, and UF Health Shands Rehab Center, University of Florida Orthopaedics and Sports Medicine Institute, Gainesville, Florida.
Phys Ther. 2016 Aug;96(8):1251-61. doi: 10.2522/ptj.20150377. Epub 2016 Feb 4.
The STarT Back Screening Tool is a validated multidimensional screening measure and risk stratification tool for people with low back pain.
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.
A cross-sectional, secondary analysis was done in this study.
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.
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.
Generalizability was restricted to physical therapy outpatients with the included pain conditions. The mSBT used in this study is not ready for clinical implementation.
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.
STarT Back筛查工具是一种经过验证的用于腰痛患者的多维筛查措施和风险分层工具。
本研究的目的是比较改良的STarT Back筛查工具（mSBT）与腰、颈、肩和膝关节疼痛患者的临床及心理测量指标之间的关系。假设是在纳入的肌肉骨骼疼痛病症中，mSBT分数与临床及心理测量指标分数之间的关系相似。
本研究采用横断面二次分析。
招募了患有腰痛（n = 118）、颈痛（n = 92）、肩痛（n = 106）或膝痛（n = 111）的参与者，并开发了一种适用于所有疼痛病症的mSBT。建立了单独的分层线性回归模型，将临床指标（健康状况、疼痛强度和残疾程度）和心理指标（运动恐惧、灾难化思维、恐惧回避、焦虑、抑郁症状和自我效能感）作为因变量。在第一步中纳入人口统计学和疼痛部位变量，在第二步中纳入mSBT分数，在最后一步中纳入疼痛部位×mSBT交互项。
在最终模型中，未发现交互作用，这表明因变量分数在不同疼痛部位之间没有差异。所有因变量的最强影响因素是mSBT分数（β = |0.32|-|0.68|）；mSBT分数越高，与越差的健康状况和自我效能感相关，以及与更高水平的疼痛强度、残疾程度、运动恐惧、灾难化思维、恐惧回避、焦虑和抑郁症状相关。
普遍性仅限于患有纳入疼痛病症的物理治疗门诊患者。本研究中使用的mSBT尚未准备好用于临床实施。
本研究结果支持使用单一测量方法对不同肌肉骨骼疼痛病症进行简明风险评估的可行性。需要进一步的纵向研究，以更好地指导mSBT在腰、颈、肩和膝关节疼痛患者中的临床应用。
