Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?

Autor: Mehling WE; Department of Family Medicine, University of California San Francisco, USA; Osher Center for Integrative Medicine, University of California San Francisco, USA., Avins AL, Acree MC, Carey TS, Hecht FM
Jazyk: angličtina
Zdroj: European journal of pain (London, England) [Eur J Pain] 2015 Mar; Vol. 19 (3), pp. 439-46.
DOI: 10.1002/ejp.615
Abstrakt: Background: The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP.
Methods: In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios.
Results: The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1.
Conclusions: A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs.
(© 2014 European Pain Federation - EFIC®)
Databáze: MEDLINE
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