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Using the STarT Back Tool: Does timing of stratification matter?

D Newell1, J Field1, D Pollard1

  • 1Anglo European College of Chiropractic, United Kingdom.

Manual Therapy
|September 2, 2014
PubMed
Summary
This summary is machine-generated.

The STarT Back Tool (SBT) may not accurately predict treatment success for nonspecific low back pain (nsLBP) patients in chiropractic care. Timing of SBT assessment did not significantly alter patient outcomes, suggesting its prognostic value needs further investigation.

Keywords:
Low back painPrognosisSTarT Back ToolStratification

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Area of Science:

  • Musculoskeletal Disorders
  • Clinical Epidemiology
  • Rehabilitation Medicine

Background:

  • Nonspecific low back pain (nsLBP) is heterogeneous, necessitating targeted treatments.
  • The STarT Back Tool (SBT) stratifies patients by risk to guide management.
  • Controversy exists regarding SBT generalizability and optimal timing of use.

Purpose of the Study:

  • To investigate if early-treatment SBT categorization is more prognostic than baseline categorization for nsLBP.
  • To assess the impact of SBT timing on patient outcomes in chiropractic care.
  • To evaluate the prognostic value of SBT in a UK chiropractic population.

Main Methods:

  • 749 patients aged 16+ recruited from 11 UK chiropractic clinics.
  • SBT categorization performed at baseline and 2 days post-initial treatment.
  • Primary outcome: Patient Global Impression of Change (PGIC) at 14, 30, and 90 days.

Main Results:

  • Patients showed similar outcomes regardless of SBT risk ranking in this chiropractic cohort.
  • Post-initial visit SBT was a predictor for medium-risk group at 30 days only.
  • Over one-third of patients changed SBT risk groups within 2 days; eventual improvement showed little difference.
  • Previous improvement strongly predicted 30- and 90-day outcomes.

Conclusions:

  • The timing of SBT stratification may not significantly impact patient outcomes in chiropractic care for nsLBP.
  • SBT's prognostic utility requires further examination, particularly concerning the timing of its application.
  • Understanding shifts in risk stratification and their prognostic implications is crucial.