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Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool.
Jacob Kneeman1, Samuel L Battalio2, Anna Korpak3
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
PM & R : the Journal of Injury, Function, and Rehabilitation
|September 9, 2020
Summary
The Subgrouping for Targeted Treatment (STarT Back) tool shows useful discrimination for predicting persistent low back pain in Veterans. However, its calibration is poor, suggesting a need for updates in Veterans Affairs primary care.
Area of Science:
- Clinical research
- Health services research
- Musculoskeletal health
Background:
- The Subgrouping for Targeted Treatment (STarT Back) tool stratifies low back pain (LBP) care.
- Its predictive validity in Veterans Affairs (VA) primary care is unestablished.
Purpose of the Study:
- To assess the STarT Back tool's accuracy in predicting persistent disabling LBP among Veterans.
- To evaluate its performance in the VA primary care setting.
Main Methods:
- A cohort study was conducted in VA primary care clinics.
- The STarT Back tool classified 538 Veterans into risk groups (low, medium, high).
- Persistent disabling LBP was defined as a Roland-Morris Disability Questionnaire score ≥7 at 6-month follow-up.
Main Results:
- STarT Back risk groups were associated with future disabling LBP (54% low, 88% medium, 97% high risk).
- The tool demonstrated useful discrimination with an area under the curve of 0.79.
- However, observed LBP prevalence was higher than in non-VA settings, indicating poor calibration.
Conclusions:
- The STarT Back tool has good predictive discrimination for LBP in Veterans.
- Poor calibration suggests the tool underestimates risk in this population.
- The STarT Back tool may require modifications for effective use in VA primary care.
