From the Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ont. (Robarts, Razmjou); the Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ont. (Robarts, Razmjou); Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Robarts, Razmjou, Yee, Finkelstein); the Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Yee, Finkelstein); and the Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ont. (Yee, Finkelstein).
From the Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ont. (Robarts, Razmjou); the Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ont. (Robarts, Razmjou); Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Robarts, Razmjou, Yee, Finkelstein); the Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Yee, Finkelstein); and the Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ont. (Yee, Finkelstein)
Can J Surg. 2022 May 17;65(3):E352-E358. doi: 10.1503/cjs.010720. Print 2022 May-Jun.
The Subgroups for Targeted Treatment for Back (STarT Back) tool is a screening questionnaire developed to identify modifiable risk factors for back pain disability in primary care. Given the ability of this tool to assist with early identification of patients at high risk, we examined its concurrent convergent and known-group construct validity in tertiary care.
This was a case-control study of adult (age > 18 yr) patients with and without an active work-related compensation claim recruited from an academic health centre between August 2017 and May 2019. Patients in the study group were assessed by a physiotherapist and an orthopedic surgeon in a spine specialty program designed to assess and treat workplace injuries. The control group included patients referred to an orthopedic spine surgeon in a publicly funded specialty clinic where an advanced practice physiotherapist determined the need for surgical consultation. We used the Roland-Morris Disability Questionnaire (RMDQ) and the Hospital Anxiety and Depression Scale (HADS) to determine the convergent and known-group construct validity of the STarT Back tool.
Fifty case and 50 control participants were included. We observed moderate to high association between the STarT Back total score, psychosocial subscore and risk categories and the RMDQ and HADS scores in the expected direction ( < 0.001). A significant association was observed between risk group allocation and depression (area under the curve values > 80), having a compensable injury and work status ( = 0.002-0.001).
The STarT Back tool was able to differentiate between patients with and without a compensable injury and patients with different levels of work status. The tool has acceptable convergent and known-group construct validity and can assist in clinical decision-making in a tertiary care setting where adjunct psychologic management may be indicated.
STarT Back 工具是一种筛选问卷，旨在识别初级保健中腰痛残疾的可改变风险因素。鉴于该工具能够帮助早期识别高风险患者，我们在三级保健中检验了其同时具有的收敛和已知组构效性。
这是一项病例对照研究，纳入了 2017 年 8 月至 2019 年 5 月期间在学术医疗中心招募的有和无在职工作相关赔偿索赔的成年（年龄 > 18 岁）患者。研究组患者由物理治疗师和骨科医生在脊柱专科计划中进行评估，该计划旨在评估和治疗工作场所伤害。对照组包括转诊至骨科脊柱外科医生的患者，在该科室由高级执业物理治疗师确定是否需要手术咨询。我们使用 Roland-Morris 残疾问卷（RMDQ）和医院焦虑和抑郁量表（HADS）来确定 STarT Back 工具的收敛和已知组构效性。
纳入了 50 例病例和 50 例对照患者。我们观察到 STarT Back 总分、心理社会亚分和风险类别与 RMDQ 和 HADS 评分之间存在中度至高度关联，且关联方向与预期一致（<0.001）。风险组分配与抑郁（曲线下面积值>80）、有赔偿伤害和工作状态之间存在显著关联（=0.002-0.001）。
STarT Back 工具能够区分有和无赔偿伤害以及不同工作状态的患者。该工具具有可接受的收敛和已知组构效性，可辅助三级保健环境中的临床决策，在这种环境下可能需要辅助心理管理。
