Convergent and known group validity of the STarT Back Tool in a Nigerian population with chronic low back pain

Abstract

Background The STarT Back Tool (SBT) was developed to aid the stratification of patients with low-back pain (LBP), based on future risks for physical disability.

Objective Investigation of the convergent and known group validity of the SBT in a Nigerian population with chronic LBP using disability-related psychosocial outcomes.

Method Cross-sectional study involved 30 consenting patients with chronic LBP in an outpatient physiotherapy clinic of a tertiary health institution in Nigeria. Future risk of disability was assessed using the SBT. Psychosocial variables of pain catastrophizing, fear-avoidance beliefs (FAB), and kinesiophobia were assessed using the Pain Catastrophizing Scale, the Fear-Avoidance Beliefs Questionnaire and the Tampa Scale of Kinesiophobia, respectively. Data was analysed using percentages and Spearman correlation.

Results Based on the SBT, there were rates of 43.3 % and 23.3 % for low and high future risks of physical disability. The median score of pain catastrophizing was 13.5, that of FAB came in at 16.5 related to physical activity and 14.0 related to work, and the score for kinesiophobia amounted to 39. The SBT total scores moderately correlated with the FAB related to work (rho = 0.45 (95 % CI 0.09–0.700). FAB related to physical activity (p = 0.040) significantly differed across the SBT subgroups.

Conclusion The SBT and the other psychosocial instruments used in this study did not correlate to a sufficient degree. In addition, patients exhibiting catastrophizing, fear-avoidance beliefs, or kinesiophobia could not be differentiated based on SBT risk groups. The results should be interpreted with caution until findings from additional studies with sufficient sample sizes are at hand.

Zusammenfassung

Hintergrund Das STarT Back Tool (SBT) wurde entwickelt, um Patientinnen und Patienten mit Rückenschmerzen in Risikogruppen, die zukünftige Risiken für Beeinträchtigungen im Alltag beschreiben, einzuteilen.

Ziel Untersuchung der konvergenten Validität und der Validität des SBT für bekannte Gruppen im Vergleich zu psychosozial ausgerichteten Instrumenten.

Methode Querschnittsstudie mit 30 Patientinnen und Patienten mit chronischen Rückenschmerzen aus einer ambulanten physiotherapeutischen Abteilung einer Einrichtung aus dem tertiären Sektor in Nigeria. Erfassung des Risikos für zukünftige Beeinträchtigung im Alltag anhand des SBT. Erfassung der psychosozialen Konstrukte Schmerzkatastrophisierung, Angstvermeidungsüberzeugungen und Kinesiophobie anhand der Schmerzkatastrophisierungsskala (Pain Catastrophizing Scale, PCS), des Fear-Avoidance-Beliefs-Fragebogens (FABQ) und der Tampa Skala für Kinesiophobia (TSK). Zur deskriptiven Datenanalyse wurden relative Häufigkeiten bestimmt. Berechnung der Spearman’sche Korrelationskoeffizienten.

Ergebnisse Anhand des SBT zeigten 43,3 % bzw. 23,3 % der Teilnehmerinnen und Teilnehmer ein niedriges bzw. hohes Risiko für zukünftige Beeinträchtigungen im Alltag. Der Median lag für Schmerzkatastrophisierung bei 13,5, für Angstvermeidungsüberzeugungen bei 16,5 (körperliche Aktivität) bzw. 14,0 (Arbeit) und für Kinesiophobie bei 39. Es bestand eine moderate Korrelation für den Zusammenhang zwischen der SBT-Gesamtpunktzahl und der FABQ-Subskala zur Arbeit (rho = 0,45 (95 % CI 0,09–0,70). Die Angstvermeidungsüberzeugungen zu körperlicher Aktivität unterscheiden sich signifikant (p = 0,04) zwischen den SBT-Subgruppen.

Schlussfolgerung Das SBT und die verwendeten psychosozialen Instrumente korrelierten nicht auf angemessenem Niveau. Zudem konnten Patientinnen und Patienten, die Katastrophisierung, Angstvermeidungsüberzeugungen oder Kinesiophobie zeigen, nicht anhand der SBT-Risikogruppen differenziert werden. Die Ergebnisse sollten zurückhaltend interpretiert werden, bis Studien mit einer angemessenen Fallzahl vorliegen.

Key words

low-back pain - disability - risk - STarT Back Tool - Nigeria

Schlüsselwörter

Rückenschmerzen - Beeinträchtigung - Risiko - StarT Back Tool - Nigeria

Publication History

Received: 26 July 2020

Accepted: 04 January 2021

Article published online:
29 March 2021

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