Kneeman Jacob, Battalio Samuel L, Korpak Anna, Cherkin Daniel C, Luo Gang, Rundell Sean D, Suri Pradeep
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Northwestern University, Evanston, IL.
PM R. 2021 Mar;13(3):241-249. doi: 10.1002/pmrj.12488. Epub 2020 Nov 9.
The Subgrouping for Targeted Treatment (STarT Back) is a stratified care approach to low back pain (LBP) treatment. The predictive validity of STarT Back in Veterans Affairs (VA) primary care has not been demonstrated.
To examine the validity of the STarT Back tool for predicting future persistent disabling LBP in VA primary care.
Cohort study.
VA primary care in Washington State.
Veterans seeking care for LBP in VA primary care clinics.
Not applicable.
The STarT Back tool was used to classify Veterans according to their baseline risk group (low vs medium vs high). The primary study outcome, persistent disabling LBP, was defined as a Roland-Morris Disability Questionnaire (RMDQ) score ≥ 7 at 6-month follow-up. Analyses examined discrimination and calibration of the baseline STarT Back risk groups for prediction of persistent disabling LBP at 6-month follow-up.
Of the study sample, 9% were female and 80% reported longstanding LBP (>5 year duration). Among 538 participants, the baseline STarT Back risk groups were associated with future persistent disabling LBP at 6-month follow-up. Within each baseline STarT Back risk group, the proportions with future persistent disabling LBP at 6-month follow-up were 54% (low risk), 88% (medium risk), and 97% (high risk). The baseline STarT Back risk groups had useful discrimination (area under the curve [AUC] 0.79) for predicting future persistent disabling LBP, but the proportion of Veterans with persistent disabling LBP at 6-month follow-up was substantially higher than that observed in non-VA primary care settings.
The STarT Back risk groups had useful discrimination (AUC = 0.79) for future persistent disabling LBP, but calibration was poor, underestimating the risk of persistent disabling LBP. The STarT Back tool may require updating for use in VA primary care.
针对性治疗分组（STarT Back）是一种用于腰痛（LBP）治疗的分层护理方法。STarT Back在退伍军人事务部（VA）初级保健中的预测效度尚未得到证实。
检验STarT Back工具在VA初级保健中预测未来持续性致残性腰痛的效度。
队列研究。
华盛顿州的VA初级保健机构。
在VA初级保健诊所寻求腰痛治疗的退伍军人。
不适用。
使用STarT Back工具根据退伍军人的基线风险组（低风险组与中风险组与高风险组）进行分类。主要研究结局，即持续性致残性腰痛，定义为在6个月随访时罗兰-莫里斯残疾问卷（RMDQ）评分≥7。分析检查了基线STarT Back风险组在预测6个月随访时持续性致残性腰痛方面的区分度和校准情况。
在研究样本中，9%为女性，80%报告有长期腰痛（病程>5年）。在538名参与者中，基线STarT Back风险组与6个月随访时未来持续性致残性腰痛相关。在每个基线STarT Back风险组中，6个月随访时出现未来持续性致残性腰痛的比例分别为54%（低风险组）、88%（中风险组）和97%（高风险组）。基线STarT Back风险组在预测未来持续性致残性腰痛方面具有有效的区分度（曲线下面积[AUC]为0.79），但6个月随访时患有持续性致残性腰痛的退伍军人比例明显高于非VA初级保健机构中的观察比例。
STarT Back风险组在预测未来持续性致残性腰痛方面具有有效的区分度（AUC = 0.79），但校准情况较差，低估了持续性致残性腰痛的风险。STarT Back工具可能需要更新以用于VA初级保健。
