Validity and reproducibility of the modified STarT Back Tool (Dutch version) for patients with neck pain in primary
Jasper D Bier1, Raymond W J G Ostelo2, Bart W Koes3
1Department of General Practice, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Fysiotherapie Fascinatio, Capelle aan den IJssel, The Netherlands.
Objective:
To evaluate the reliability and validity of the Dutch version of the STarT Back screening Tool (SBT), for patients with neck pain.
Methods:
We modified the SBT to fit patients with neck pain. General practitioners and physiotherapists included patients who completed both a baseline and a follow-up questionnaire at 3 days and 3 months, respectively. The construct validity was assessed using Pearson's correlation between the SBT and the reference questionnaires. The reproducibility was assessed in the first week using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using a relative-risk ratio (RR) for, amongst others, persisting disability at 3 months. Content validity was analysed using both floor and ceiling effects.
Results:
In total, 100 patients were included; 58% were categorised as being at "low risk" for persisting disability, 37% at "medium risk" and 5% at "high risk". As expected for the construct validity, we found a moderate to high correlation for all questions except for activity question 3. The reproducibility had a quadratic-weighted kappa of 0.58, and a specific agreement of 90.9% for "low-risk" and 66.7% for "medium-risk" patients. The RRs for persisting disability for "medium-risk" against "low-risk" patients were 1.5 (95% C.I. 0.9-2.4) and 1.5 (95% C.I. 0.5-4.1) for pain. The sample size for high-risk patients was low.
Conclusion:
The original SBT is modified to fit patients with neck pain in Dutch primary care. The psychometric analysis indicates sufficiently reliable outcomes, although the predictive validity showed statistically insignificant results.
