Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal lab, Avenue Mounier 53/B1.53.07, 1200 Brussels, Belgium.
Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10/1650, 1200 Brussels, Belgium.
Ann Phys Rehabil Med. 2019 May;62(3):178-188. doi: 10.1016/j.rehab.2018.09.007. Epub 2018 Oct 19.
Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice.
This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration<3months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC).
Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS≥3 at 3 months (AUC=0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index≥30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes.
The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other.
预防慢性腰痛需要准确识别高危患者。目前已有多种问卷进行验证，包括 STarT 背部筛查工具（SBST）和 Örebro 肌肉骨骼疼痛筛查问卷（OMPSQ）。本综述旨在比较这两种问卷在预测价值和目标方面的差异，为临床实践中的选择提供指导。
本研究为半系统文献综述。从 Pubmed 数据库中选择了评估至少一种问卷且发表于 1997 年至 2017 年 10 月 10 日的研究。纳入标准为疼痛持续时间<3 个月，结局包括疼痛、功能和/或整体恢复。对于工作结局，纳入标准扩展为慢性患者。研究必须提供敏感性、特异性和 ROC 曲线下面积（AUC）信息。
共纳入 28 项研究（7 项 SBST，21 项原始 OMPSQ，3 项短 OMPSQ）。OMPSQ 最佳预测了 3 个月（AUC=0.64（0.50-0.78））和 6 个月（AUC 在 0.70（未提供置信区间）至 0.84（0.71-0.97）之间）时疼痛 NRS≥3。SBST 和 OMPSQ 在预测 6 个月时 Oswestry 残疾指数≥30%方面相当。仅有一项研究表明，SBST 和 OMPSQ 在预测 6 个月时缺勤≥30 天方面无差异。这两种问卷不能相互比较“整体恢复”结局。
OMPSQ 似乎优于 SBST 预测“疼痛”和“工作”结局，SBST 可能更适合预测“功能”结局。由于研究之间存在高度异质性，应谨慎对待这些结果。需要注意的是，OMPSQ 是为了创建一个预后工具而制定的，而 SBST 是为了作为一种治疗分配工具而制定的，在临床实践中更容易使用。这应该指导选择使用其中一种问卷而不是另一种。
