Bier Jasper D, Ostelo Raymond W J G, van Hooff Miranda L, Koes Bart W, Verhagen Arianne P
Department of General Practice, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, the Netherlands, and Fysiotherapie Fascinatio, Capelle aan den Ijssel, the Netherlands.
Department of Epidemiology and Biostatistics, VU University Medical Centre; EMGO Institute for Health and Care Research; and Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands.
Phys Ther. 2017 May 1;97(5):561-570. doi: 10.1093/ptj/pzx023.
The purpose of this study was to translate and to investigate the reliability and validity of the STarT Back screening tool (SBT) in the primary care setting among patients with nonspecific low back pain (LBP).
The SBT was formally translated into Dutch following a multistep approach for forward and backward translation. General practitioners and physical therapists included patients with LBP.
Patients completed a baseline questionnaire and a follow-up at 3 days and 3 months. The construct validity was calculated with Pearson's correlation coefficient. The reproducibility was assessed using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using relative risk ratios for persisting disability at 3 months. Content validity was analyzed using floor and ceiling effects.
In total, 184 patients were included; 52.2% were categorized in the "low-risk" subgroup, 38.0% "medium-risk," and 9.8% "high-risk." For the construct validity we found, as expected, a moderate to high Pearson's correlation for questions 3 to 9 and a low correlation for questions 1 and 2 with their respective reference questionnaires. The reproducibility had a quadratic weighted kappa of 0.65 and the specific agreement of 82.4% for "low-risk," 53.3% for "medium-risk," and 33.3% for "high-risk." For the predictive validity for persisting disability we found a relative risk ratio for "medium-risk" of 1.8 (95% confidence interval [CI]: 1.0-3.1) and 2.7 (95% CI: 1.4-4.9) for "high-risk" compared with "low-risk." For the content validity, we found that no floor and ceiling effects were present.
There was a relatively small sample size for the retest reliability study. Patients were not compared between physical therapist and GP, as there were not enough patients in both groups. For practical reasons, the patients filled out the baseline questionnaire after receiving the first treatment/consultation; however, the questionnaire is intended to be filled in before the first consultation/treatment.
The SBT has been successfully translated into Dutch. The psychometric analysis showed acceptable results and, therefore, the SBT is a valid screening tool for patients with LBP in Dutch primary care.
本研究旨在翻译并调查STarT Back筛查工具（SBT）在初级保健环境中对非特异性腰痛（LBP）患者的可靠性和有效性。
按照多步骤的正向和反向翻译方法，将SBT正式翻译成荷兰语。全科医生和物理治疗师纳入了LBP患者。
患者完成一份基线问卷，并在3天和3个月时进行随访。使用Pearson相关系数计算结构效度。使用二次加权kappa和具体一致性评估再现性。使用3个月时持续残疾的相对风险比评估预测效度。使用地板效应和天花板效应分析内容效度。
总共纳入了184名患者；52.2%被归类为“低风险”亚组，38.0%为“中等风险”，9.8%为“高风险”。对于结构效度，正如预期的那样，我们发现问题3至9与各自的参考问卷具有中度至高的Pearson相关性，而问题1和2的相关性较低。再现性的二次加权kappa为0.65，“低风险”的具体一致性为82.4%，“中等风险”为53.3%，“高风险”为33.3%。对于持续残疾的预测效度，我们发现“中等风险”与“低风险”相比的相对风险比为1.8（95%置信区间[CI]：1.0 - 3.1），“高风险”为2.7（95%CI：1.4 - 4.9）。对于内容效度，我们发现不存在地板效应和天花板效应。
重测信度研究的样本量相对较小。由于两组患者数量不足，未对物理治疗师和全科医生的患者进行比较。出于实际原因，患者在接受首次治疗/咨询后填写基线问卷；然而，该问卷旨在在首次咨询/治疗前填写。
SBT已成功翻译成荷兰语。心理测量分析显示结果可接受，因此，SBT是荷兰初级保健中LBP患者的有效筛查工具。
