The prognostic ability of the STarT Back Tool was affected by episode duration
The prognostic ability of the STarT Back Tool was affected by episode duration
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DOI：
10.1007/s00586-015-3915-0
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发表时间：
2016-03-01
影响因子：
2.8
通讯作者：
Kent, Peter
中科院分区：
文献类型：
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作者：
Morso, Lars;Kongsted, Alice;Kent, Peter
据报道，STarT - Back工具（SBT）的预测能力各不相同，但影响因素尚不清楚。本研究调查了护理环境（捏脊、全科医生、物理治疗、脊柱中心）、发作持续时间（0-2、3-4、4-12、10 -12周）和结局时间（3、6、12个月）对SBT预后能力的影响。这是对三个初级保健队列[脊椎指压治疗（n = 416），全科医生（n = 265）和物理治疗（n = 200）实践]和一个来自丹麦二级保健门诊脊柱中心的队列（n = 974）的数据进行的二次分析。护理途径不受SBT风险亚组（非分层护理）的系统性影响。使用广义估计方程，我们研究了SBT风险亚组之间的统计相互作用和潜在影响因素对SBT亚组预后能力的影响，当罗兰莫里斯残疾问卷得分为结果时。SBT风险亚组、年龄、护理环境和发作持续时间都是独立的预后因素。唯一被调查的改变SBT亚组预后能力的因素是发作持续时间。这些结果表明，在这些非分层护理环境中，SBT的预后能力不受护理环境本身的影响。然而，患者的预后受到不同患者群体的不同临床特征的影响，其中许多临床特征未被SBT评估。当控制这些因素并测试潜在的相互作用时，结果显示只有发作持续时间影响SBT的预后能力，特别是在非常急性的患者（< 2周持续时间）中，SBT的预测能力较差。
The prognostic ability of the STarT Back Tool (SBT) reportedly varies, but the factors affecting this are unclear. This study investigated the influences of care setting (chiropractic, GP, physiotherapy, spine centre), episode duration (0-2, 3-4, 4-12, > 12 weeks), and outcome time period (3, 6, 12 months) on SBT prognostic ability.This was a secondary analysis of data from three primary care cohorts [chiropractic (n = 416), GP (n = 265), and physiotherapy (n = 200) practices] and one cohort from a secondary care outpatient spine centre (n = 974) in Denmark. Care pathways were not systematically affected by SBT risk subgroup (non-stratified care). Using generalised estimating equations, we investigated statistical interactions between SBT risk subgroups and potentially influential factors on the prognostic ability of the SBT subgroups, when Roland Morris Disability Questionnaire scores were the outcome.SBT risk subgroup, age, care setting, and episode duration were all independent prognostic factors. The only investigated factor that modified the prognostic ability of the SBT subgroups was episode duration.These results indicate that the prognostic ability of the SBT in these non-stratified care settings was unaffected by care setting on its own. However, the prognosis of patients is affected by diverse clinical characteristics that differ between patient populations, many of which are not assessed by the SBT. When controlling for some of those factors and testing potential interactions, the results showed that only episode duration affected the SBT prognostic ability and, specifically, that the SBT was less predictive in very acute patients (< 2 weeks duration).