Highlights
- •We compared 2 screening approaches for identifying pain-related distress.
- •STarT Back Tool (SBT) risk-dependent relationships were identified.
- •Depressive symptoms were strongly related to SBT high-risk categorization.
- •Clinicians need to be aware of misclassification when using the SBT.
- •Alternative subgroup methods could potentially improve screening outside primary care.
Abstract
Early screening for psychological distress has been suggested to improve patient management
for individuals experiencing low back pain. This study compared 2 approaches to psychological
screening (ie, multidimensional and unidimensional) so that preliminary recommendations
on which approach may be appropriate for use in clinical settings other than primary
care could be provided. Specifically, this study investigated aspects of the STarT
Back Screening Tool (SBT): 1) discriminant validity by evaluating its relationship
with unidimensional psychological measures and 2) construct validity by evaluating
how SBT risk categories compared to empirically derived subgroups using unidimensional
psychological and disability measures. Patients (N = 146) receiving physical therapy
for LBP were administered the SBT and a battery of unidimensional psychological measures
at initial evaluation. Clinical measures consisted of pain intensity and self-reported
disability. Several SBT risk–dependent relationships (ie, SBT low < medium < high
risk) were identified for unidimensional psychological measure scores, with depressive
symptom scores associated with the strongest influence on SBT risk categorization.
Empirically derived subgroups indicated that there was no evidence of distinctive
patterns among psychological or disability measures other than high or low profiles;
therefore, 2 groups may provide a clearer representation of the level of pain-associated
psychological distress, maladaptive coping, and disability in this setting compared
with 3 groups as suggested when using the SBT in primary care settings.
Perspective
This study suggests that the SBT can replace administering several unidimensional
psychological measures as a first-line screening measure for psychological distress.
However, clinicians need to be aware of the potential for misclassification with SBT
results when compared to unidimensional measures. This study also suggests that a
modified SBT risk stratification scheme based on empirically derived subgroups could
potentially assist in identifying elevated levels of pain-associated psychological
distress, maladaptive coping, and disability in practice settings outside of primary
care. Patients identified with elevated levels of pain-associated distress and maladaptive
coping may be indicated for additional assessment using construct-specific questionnaires.
Key words
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Article info
Publication history
Published online: October 21, 2014
Accepted:
October 8,
2014
Received in revised form:
October 2,
2014
Received:
November 27,
2013
Footnotes
This study was funded by a 2009 award from the Brooks Health System to the University of Florida Foundation. J.M.B. was supported by a National Institutes of Health T32 Neuromuscular Plasticity Research Training Fellowship grant (T32 HD043730). This manuscript was written while J.M.B. received support from the National Institutes of Health Rehabilitation Research Career Development Program (K12-HD055929).
The authors declare no financial interest in the results of this research.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
