Department of Research and Development, National Center for Spinal Disorders, Budapest, Hungary.
Doctoral School of Clinical Medicine, Semmelweis University School of Ph.D. Studies, Budapest, Hungary.
Disabil Rehabil. 2022 Apr;44(8):1427-1435. doi: 10.1080/09638288.2020.1799248. Epub 2020 Jul 31.
The STarT Back Tool was developed to identify the specific modifiable prognostic factors for non-specific low back pain and to classify the patients into risk groups; low, medium and high risk of chronicity. Applied therapeutic approaches often involve group physical therapy. The aim of this study was the cross-cultural adaptation and validation of the Hungarian version of the STarT Back Tool and to investigate the predictive ability for global treatment outcome.
A prospective cohort study ( = 133) was carried out involving non-specific low back pain patients. Internal consistency, construct validity, reliability and prognostic discriminative ability have been investigated. After 3 months of treatment global outcome was evaluated.
A 2-factor structure was found, with moderate internal consistency (Cronbach α = 0.89 for the total and psychosocial subscale 0.62). Between the Hungarian STarT Back Tool, the Oswestry Disability Index, leg pain, low back pain, Tampa Scale for Kinesiophobia, Fear Avoidance Beliefs Questionnaire and the physical subscale of the quality of life questionnaire, significant good to excellent- correlation was found ( > 0.41). The test-retest analysis showed excellent reliability (Intraclass Correlation Coefficient = 0.93) with standard error measurement being 0.49 (minimal detectable change = 1.37). The Area Under the Curve for baseline STarT Back Tool scores was 0.7 and 0.8 for global treatment outcome and distress, respectively. The Area Under the Curve for global treatment outcome versus STarT risk groups proved to be 0.76 representing adequate discriminative ability.
The successful cross-cultural adaptation was followed by the validity analysis and as a result the Hungarian version of the STarT Back Tool proved to be a reliable and valid tool in the identification of risk groups of chronicity for patients with low back pain. Patients allocated to the high-risk group were more likely experiencing poor outcome at 3 months follow up, thus it can be used to predict outcome if treated with group physical therapy.Implication for rehabilitationLow back pain is a multifactorial disease where physical and psychosocial risk factors play a role in the development and prognosis of the disease.The STarT-H can be considered as a reliable, valid measurement tool in the identification of risk groups of chronicity for patients with low back pain.Clinical relevance of the STarT-H is that it can be used to stratify patients into risk groups of chronicity in different Hungarian speaking healthcare settings.According to our findings the STarT-H can also be applied to predict global treatment outcome in low back pain patients if treated with group physical therapy.
STarT Back 工具旨在确定非特异性下腰痛的特定可改变预后因素，并将患者分为低、中、高慢性风险组。应用的治疗方法通常涉及团体物理治疗。本研究的目的是对匈牙利语版本的 STarT Back 工具进行跨文化适应性和验证，并研究其对整体治疗结果的预测能力。
进行了一项前瞻性队列研究（n=133），涉及非特异性下腰痛患者。研究了内部一致性、结构效度、可靠性和预后判别能力。治疗 3 个月后评估整体治疗结果。
发现存在 2 个因子结构，具有中度内部一致性（STarT 总分的 Cronbach α为 0.89，心理社会分量表为 0.62）。匈牙利语版 STarT Back 工具与 Oswestry 残疾指数、腿部疼痛、下腰痛、Tampa 运动恐惧量表、恐惧回避信念问卷和生活质量问卷的身体分量表之间存在显著良好至极好相关性（>0.41）。测试-重测分析显示具有极好的可靠性（组内相关系数=0.93），标准测量误差为 0.49（最小可检测变化=1.37）。基线 STarT Back 工具评分的曲线下面积（AUC）分别为 0.7 和 0.8，用于评估整体治疗结果和痛苦。整体治疗结果与 STarT 风险组的 AUC 为 0.76，表明具有足够的判别能力。
成功进行了跨文化适应性调整，随后进行了有效性分析，结果表明匈牙利语版 STarT Back 工具在识别慢性低腰痛患者的慢性风险组方面是可靠和有效的。在 3 个月随访时，分配到高风险组的患者更有可能出现不良结局，因此如果接受团体物理治疗，它可用于预测结局。
下腰痛是一种多因素疾病，其中物理和心理社会危险因素在疾病的发展和预后中起作用。STarT-H 可作为一种可靠、有效的测量工具，用于识别慢性低腰痛患者的慢性风险组。STarT-H 在不同讲匈牙利语的医疗保健环境中可用于将患者分层为慢性风险组，具有临床意义。根据我们的发现，如果对下腰痛患者进行团体物理治疗，STarT-H 也可用于预测整体治疗结果。
