Article

Psychologically informed practice emphasizes routine identification
of modifiable psychological risk factors being highlighted. The
purpose of this study was to test the predictive validity of the STarT Back
Screening Tool (SBT) in comparison with single-construct psychological measures
for 6-month clinical outcomes. DESIGN: This was an observational, prospective
cohort study. METHODS: Patients (n=146) receiving physical therapy for low back
pain were administered the SBT and a battery of psychological measures
(Fear-Avoidance Beliefs Questionnaire physical activity scale and work scale
[FABQ-PA and FABQ-W, respectively], Pain Catastrophizing Scale [PCS], 11-item
version of the Tampa Scale of Kinesiophobia [TSK-11], and 9-item Patient Health
Questionnaire [PHQ-9]) at initial evaluation and 4 weeks later. Treatment was at
the physical therapist's discretion. Clinical outcomes consisted of pain
intensity and self-reported disability. Prediction of 6-month clinical outcomes
was assessed for intake SBT and psychological measure scores using multiple
regression models while controlling for other prognostic variables. In addition,
the predictive capabilities of intake to 4-week changes in SBT and psychological
measure scores for 6-month clinical outcomes were assessed. RESULTS: Intake pain
intensity scores (beta=.39 to .45) and disability scores (beta=.47 to .60) were
the strongest predictors in all final regression models, explaining 22% and 24%
and 43% and 48% of the variance for the respective clinical outcome at 6 months.
Neither SBT nor psychological measure scores improved prediction of 6-month pain
intensity. The SBT overall scores (beta=.22) and SBT psychosocial scores
(beta=.25) added to the prediction of disability at 6 months. Four-week changes
in TSK-11 scores (beta=-.18) were predictive of pain intensity at 6 months.
Four-week changes in FABQ-PA scores (beta=-.21), TSK-11 scores (beta=-.20) and
SBT overall scores (beta=-.18) were predictive of disability at 6 months.
LIMITATIONS: Physical therapy treatment was not standardized or accounted for in
the analysis. CONCLUSIONS: Prediction of clinical outcomes by psychology-based
measures was dependent upon the clinical outcome domain of interest. Similar to
studies from the primary care setting, initial screening with the SBT provided
additional prognostic information for 6-month disability and changes in SBT
overall scores may provide important clinical decision-making information for
treatment monitoring.

Langue : ANGLAIS