The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings

Beneciuk, Jason M.; Bishop, Mark D.; Fritz, Julie M.; Robinson, Michael E.; Asal, Nabih R.; Nisenzon, Anne N.; George, Steven Z.

doi:10.2522/ptj.20120207

Cited by 185Musculoskeletal pain and rehabilitationMedical Practices and RehabilitationPain Management and Treatment

The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings

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Beneciuk, Jason M., Bishop, Mark D., Fritz, Julie M., Robinson, Michael E., Asal, Nabih R., Nisenzon, Anne N., George, Steven Z.·2013·Physical Therapy

DOI 10.2522/ptj.20120207PMC PMC3588106

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Abstract

Background: Psychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted. Objective: 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 (β=.39 to .45) and disability scores (β=.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 (β=.22) and SBT psychosocial scores (β=.25) added to the prediction of disability at 6 months. Four-week changes in TSK-11 scores (β=−.18) were predictive of pain intensity at 6 months. Four-week changes in FABQ-PA scores (β=−.21), TSK-11 scores (β=−.20) and SBT overall scores (β=−.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.

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The items used for impact stratification (pain intensity, pain interference, and functional status) have substantial research support for their discriminatory and prognostic importance.
“These items have substantial research support to validate their discriminatory and prognostic importance. 13, 19, 31, 38, 39, 43, 47–49, 53, 54, 57–60, 66–68, 73, 76, 80, 82, 85, 86, 97, 106, 108, 110, 112–116, 122”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [13]
The STaRT Back Tool was developed in UK primary care and is designed to help physicians in the assessment of patients at risk of progressing from acute to chronic low back pain.
“The STaRT Back Tool was developed in UK primary care and is designed to help physicians in the assessment of patients at risk of progressing from acute to chronic low back pain (LBP) [25].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [25]
The STaRT Back Tool stratifies patients into low, medium and high risk and recommends appropriate treatment for each patient based on their risk level.
“It stratifies patients into low, medium and high risk and recommends appropriate treatment for each patient based on their risk level [25].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [25]

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Evaluation of the STarT Back Screening Tool for Prediction of Low Back Pain Intensity in an Outpatient Physical Therapy Setting
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The STarT Back Screening Tool for Prediction of 6-Month Clinical Outcomes: Relevance of Change Patterns in Outpatient Physical Therapy Settings
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Relationship between categorization with the STarT Back Screening Tool and prognosis for people receiving physical therapy for low back pain
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Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study
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Authors: Beneciuk, J. M., Bishop, M. D., Fritz, J. M., Robinson, M. E., Asal, N. R., Nisenzon, A. N., & George, S. Z.
Affiliations: University of Florida (US)
Intermountain Healthcare (US)
University of Florida Health (US)
Corresponding author: Beneciuk, Jason M.
George, Steven Z.
ORCID: Beneciuk, Jason M.
Bishop, Mark D.
Fritz, Julie M.
Robinson, Michael E.
George, Steven Z.
Venue: Physical Therapy
Publisher: Oxford University Press (OUP)
Published: 2013-03-01
Volume: 93
Issue: 3
Pages: 321-333
ISSN: 0031-9023 (ISSN-L)
1538-6724
DOI: 10.2522/ptj.20120207
PMC: PMC3588106
OpenAlex: W2133262543
Cited by: 185
References: 74
Citations by year: 2026: 4 · 2025: 10 · 2024: 12 · 2023: 16 · 2022: 15 · 2021: 17 · 2020: 19 · 2019: 18 · 2018: 12 · 2017: 10 · 2016: 11 · 2015: 19 · 2014: 13 · 2013: 7
FWCI: 9.17
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Physical Therapy (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD043730)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: STarT Back Screening Tool, low back pain, prognostic validity, psychological risk factors, fear-avoidance beliefs, pain catastrophizing, kinesiophobia, depression, physical activity, disability, pain intensity, psychological screening, Tampa Scale for Kinesiophobia, Patient Health Questionnaire, Pain Catastrophizing Scale, Fear-Avoidance Beliefs Questionnaire
MeSH terms: Disability Evaluation, Fear, Female, Humans, Male, Pain Measurement, Predictive Value of Tests, Prognosis, Prospective Studies, Surveys and Questionnaires, Regression Analysis, Risk Factors, Treatment Outcome, Low Back Pain, Physical Therapy Modalities

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The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings

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