Abstract
Back pain outcomes may be improved and costs lowered through risk-stratified care,
but relative performance of alternative item sets for predicting back pain outcomes
has not been well characterized. We compared alternative prognostic item sets based
on STarT Back and Chronic Pain Risk screeners in a cohort of patients initiating primary
care for back pain. The STarT Back item set was brief and relied on binary responses,
whereas the Chronic Pain Risk item set employed scaled responses and assessed pain
persistence and diffuse pain. Patients (N = 571) were assessed soon after their initial
visit and 502 (88%) were reassessed 4 months later. Items sets based on STarT Back
and Chronic Pain Risk prognostic screeners, as well as a combination of items from
both, were used to predict Chronic Pain Grade II-IV back pain at 4 months. The area
under the receiver operating characteristic curve estimates (95% confidence intervals)
were .79 (.74–.83) for items based on the STarT Back, .80 (.75–.83) for items based
on Chronic Pain Risk, and .81 (.77–.85) for a composite item set. Differences in prediction
were modest. Items from 2 prognostic screeners, and both combined, achieved acceptable
and similar prediction of unfavorable back pain outcomes.
Perspective
Given comparable predictive validity, choice among prognostic item sets should be
based on clinical relevance, number of items, ease of administration, and item simplicity.
Key words
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Article info
Publication history
Published online: December 02, 2013
Accepted:
September 24,
2013
Received in revised form:
September 10,
2013
Received:
June 25,
2013
Footnotes
This research was funded by a grant from Janssen Pharmaceuticals Inc. M.V.K. is an investigator on research grants to Group Health Research Institute from Pfizer Inc. S.M.S. has received funding from research grants awarded to Group Health Research Institute by Bristol Meyers Squibb. J.A.B. is an employee of Johnson and Johnson Inc companies that market products for pain management. P.S. is an employee of Janssen Research and Development. The authors have no other competing interests relevant to this research to report.
This research was funded by a grant from Janssen Pharmaceuticals Inc. The research was approved by the Group Health Institutional Review Board.
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Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
