Fu Yanyan, Jenks Alan D, Rubinstein Sidney M, de Luca Katie, Axen Iben, Koes Bart W, Chiarotto Alessandro
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
School of Kinesiology, Faculty of Global & Community Studies, Capilano University, North Vancouver, Canada.
Chiropr Man Therap. 2025 Jul 30;33(1):30. doi: 10.1186/s12998-025-00592-1.
Low back pain (LBP) is common among older adults, and it is a frequent reason for seeking chiropractic care. The STarT Back Screening Tool (SBT) was developed to stratify patients with LBP into low, medium, and high-risk treatment pathways, so that the treatment can be matched to each participant's risk profile. But its prognostic performance varies across settings and populations. No studies have focused on the SBT's utility as a stratified-care tool in older adults with LBP in a chiropractic setting. Therefore, our aim was to evaluate the ability of the SBT to predict three-, six-, and 12-month disability and pain outcomes in older adults (≥55 years) with a new episode of LBP consulting chiropractors in the Netherlands, Sweden, and Australia.
This was a secondary analysis of the Back Complaints in Older Adults - Chiropractic (BACE-C) cohort. Participants visiting chiropractors with LBP completed baseline questionnaires for demographic and clinical characteristics, including the SBT. Follow-up questionnaires assessed disability (Roland Morris Disability Questionnaire (RMDQ)) and pain intensity (11-point Numerical Rating Scale (NRS)). "No improvement" on disability and pain intensity was defined as less than 30% reduction in baseline scores. We used logistic regression models to estimate discrimination metrics including the area under the receiver operating characteristic curve (AUC). Subgroup analyses were conducted by country, sex, and LBP duration; sensitivity analyses employed alternative "no improvement" definitions and linear regression on continuous outcome scores.
A total of 738 participants were included. The mean age of the study sample was 66.2 ± 7.5 years and 50.9% of the participants were female. The SBT showed poor discrimination for predicting no improvement in disability and pain intensity. All AUC values were below 0.60 regardless of whether SBT risk subgroups (i.e. low/medium/high) or the SBT sum score were used. Subgroup and sensitivity analyses did not meaningfully improve discrimination.
The SBT presented limited prognostic ability to predict outcomes of disability and pain intensity in older adults with LBP in a chiropractic setting. These findings suggest insufficient evidence for the prognostic ability of the SBT risk stratification tool. Future research should explore reasons behind the limited prognostic accuracy and consider potential modifications or alternative tools.
下背痛（LBP）在老年人中很常见，也是寻求脊椎按摩治疗的常见原因。开发了STarT Back筛查工具（SBT），以将LBP患者分为低、中、高风险治疗路径，以便使治疗能够与每个参与者的风险概况相匹配。但其预后性能因环境和人群而异。尚无研究关注SBT作为脊椎按摩治疗环境中LBP老年人分层护理工具的效用。因此，我们的目的是评估SBT预测荷兰、瑞典和澳大利亚患有新发LBP并咨询脊椎按摩师的老年人（≥55岁）在3个月、6个月和12个月时残疾和疼痛结局的能力。
这是对老年人脊椎按摩治疗背痛（BACE-C）队列的二次分析。因LBP就诊于脊椎按摩师的参与者完成了关于人口统计学和临床特征的基线问卷，包括SBT。随访问卷评估残疾情况（罗兰·莫里斯残疾问卷（RMDQ））和疼痛强度（11点数字评定量表（NRS））。残疾和疼痛强度“无改善”定义为基线分数降低不到30%。我们使用逻辑回归模型来估计包括受试者工作特征曲线下面积（AUC）在内的鉴别指标。按国家、性别和LBP持续时间进行亚组分析；敏感性分析采用替代的“无改善”定义，并对连续结局分数进行线性回归。
共纳入738名参与者。研究样本的平均年龄为66.2±7.5岁，50.9%的参与者为女性。SBT在预测残疾和疼痛强度无改善方面显示出较差的鉴别能力。无论使用SBT风险亚组（即低/中/高）还是SBT总分，所有AUC值均低于0.60。亚组和敏感性分析并未显著改善鉴别能力。
在脊椎按摩治疗环境中，SBT预测LBP老年人残疾和疼痛强度结局的预后能力有限。这些发现表明，SBT风险分层工具的预后能力证据不足。未来的研究应探索预后准确性有限背后的原因，并考虑潜在的修改或替代工具。
