Unsgaard-Tøndel Monica, Kregnes Ingunn Gunnes, Nilsen Tom I L, Marchand Gunn Hege, Askim Torunn
Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, N-7491, Trondheim, Norway.
Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway.
BMC Musculoskelet Disord. 2018 May 24;19(1):166. doi: 10.1186/s12891-018-2082-y.
Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories.
An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen's Kappa coefficient, Pearson's r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool.
A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ.
The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.
非特异性腰痛的特点是存在多种可能的触发因素和促成因素，初始筛查需要广泛涵盖可能导致疼痛体验的多个层面的因素。已开发出患者分类筛查工具以辅助临床医生。本研究的主要目的是在挪威因腰痛转诊至二级护理的患者样本中，评估STarT Back筛查工具（STarT Back）相对于更全面的厄勒布鲁肌肉骨骼疼痛问卷（ÖMPSQ）的标准效度。次要目的是评估两种工具所指示的患者风险分类，并比较不同STarT Back风险类别患者之间的疼痛和工作特征。
在挪威特隆赫姆大学医院接受门诊二级护理评估的腰痛患者中进行一项观察性横断面调查。使用科恩卡方系数、皮尔逊r系数和布兰德-奥特曼图来评估STarT Back相对于ÖMPSQ的标准效度。此外，使用线性回归来估计STarT Back工具定义的风险组之间在疼痛和工作相关变量方面的平均差异及95%置信区间。
共有182人参与研究。ÖMPSQ和STarT Back得分之间的皮尔逊相关系数为0.76。两种工具分类一致性的卡方值为0.35。根据STarT Back进行的风险组分类将34.1%的患者归为低风险组，42.3%归为中风险组，23.6%归为高风险组。根据ÖMPSQ，24.7%的参与者被归为低风险组，28.6%归为中风险组，46.7%归为高风险组。根据STarT Back分类为高风险的患者在ÖMPSQ测量的疼痛和工作相关特征方面得分更高。
筛查工具得分之间的相关性良好，但筛查工具之间的分类一致性较低。对于转诊至二级护理进行多学科管理的患者，筛查工作因素可能很重要。
