The STarT Back Screening Tool and Individual Psychological Measures: Evaluation of Prognostic Capabilities for Low Back Pain Clinical Outcomes in Outpatient Physical Therapy Settings
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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DOI：
10.2522/ptj.20120207
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发表时间：
2013-03-01
期刊：
影响因子：
3.2
通讯作者：
George, Steven Z.
中科院分区：
文献类型：
--
作者：
Beneciuk, Jason M.;Bishop, Mark D.;George, Steven Z.
背景心理知情实践强调常规识别可修改的心理风险因素被突出。本研究的目的是测试的预测有效性的STartT回筛选工具（SBT）相比，单一结构的心理措施，为6个月的临床结局。这是一项观察性、前瞻性队列研究。对146例接受物理治疗的腰痛患者进行了SBT和一系列心理测量（恐惧回避信念问卷身体活动量表和工作量表[分别为FABQ-PA和FABQ-W]，疼痛灾难化量表[PCS]，11项版本的坦帕运动恐惧量表[TSK-11]，和9项患者健康问卷[PHQ-9]）。治疗由理疗师决定。临床结果包括疼痛强度和自我报告的残疾。在控制其他预后变量的同时，使用多元回归模型评估摄入SBT和心理测量评分对6个月临床结局的预测。此外，还评估了摄入量对4周SBT变化和心理测量评分对6个月临床结局的预测能力。在所有最终回归模型中，摄入疼痛强度评分（β = 0.39至0.45）和残疾评分（β = 0.47至0.60）是最强的预测因子，分别解释了6个月时各自临床结局方差的22%和24%以及43%和48%。SBT和心理测量评分均未改善6个月疼痛强度的预测。SBT总分（β = 0.22）和SBT心理社会评分（β = 0.25）增加了6个月时残疾的预测。TSK-11评分的四周变化（β =-0.18）可预测6个月时的疼痛强度。FABQ-PA评分（β =-0.21）、TSK-11评分（β =-0.20）和SBT总分（β =-0.18）的四周变化可预测6个月时的残疾。物理疗法治疗没有标准化或占分析。通过基于心理学的测量预测临床结果取决于感兴趣的临床结果领域。与来自初级保健环境的研究相似，SBT的初始筛查提供了6个月残疾的额外预后信息，SBT总分的变化可能为治疗监测提供重要的临床决策信息。
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 (beta = .39 to .45) and disability scores (beta = .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 (beta = .22) and SBT psychosocial scores (beta = .25) added to the prediction of disability at 6 months. Four-week changes in TSK-11 scores (beta = -.18) were predictive of pain intensity at 6 months. Four-week changes in FABQ-PA scores (beta = -.21), TSK-11 scores (beta = -.20) and SBT overall scores (beta = -.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.