Using the STarT Back Tool: Does timing of stratification matter?
Using the STarT Back Tool: Does timing of stratification matter?
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DOI：
10.1016/j.math.2014.08.001
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发表时间：
2015-08-01
期刊：
影响因子：
--
通讯作者：
Pollard, D.
中科院分区：
文献类型：
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作者：
Newell, D.;Field, J.;Pollard, D.
非特异性LBP（nsLBP）患者很可能构成一个异质性群体，将治疗适当地针对那些最有可能应答的患者具有重要意义。STarT Back Tool（SBT）已被开发用于将患者分为风险组，以帮助管理选择。然而，有争议的普遍性和不确定性的时间use.This研究调查是否SBT分类早期的治疗过程中将证明更预后比分类患者在baseline.七百四十九名患者年龄在16岁以上，招募了11个脊椎按摩诊所在英国。在就诊时和初始治疗后2天使用SBT对这些患者进行分类，同时在基线时收集患者特征和疾病特异性标志物。主要结果是在初次访视后14、30和90天收集的患者总体印象变化（PGIC），在接受脊椎按摩治疗的人群中，无论患者的STarT风险等级如何，患者的结局相似。多变量预后模型仅包括初次访视后SBT作为中等风险组有利结局的独立预测因素，但仅在30天。在30和90天模型中，随访改善主要是由先前的改善所主导。超过三分之一的患者在初始分层和初始访视后的2天内交换了SBT风险组，尽管在随访时最终改善的差异很小。了解SBT分层时机的影响。(C)2014爱思唯尔有限公司版权所有。
It is likely that individuals with nonspecific LBP (nsLBP) constitute a heterogenic group and targeting treatment appropriately to those most likely to respond is of major relevance.The STarT Back Tool (SBT) has been developed to stratify patients into risk groups to aid management choices. However, there is controversy over its generalisability and uncertainty as to the timing of use.This study investigated whether SBT categorisation early in a course of treatment would prove more prognostic than categorising patients at baseline.Seven hundred and forty nine patients over the age of 16 were recruited at 11 chiropractic clinics within the UK. The SBT was used to categorise these patients at presentation and 2 days following initial treatment with patient characteristics and condition specific markers also collected at baseline. The primary outcome was the Patient Global Impression of Change (PGIC) collected at 14, 30 and 90 days following the initial visit.In this population undergoing chiropractic care, patients had similar outcomes irrespective of their STarT back risk ranking.Multivariate prognostic models included only the post initial visit SBT as an independent predictor of favourable outcome for the medium risk group but only at 30 days. Follow up improvement was dominated by previous improvement in 30 and 90-day models.Over one third of patients swapped SBT risk groups in the 2 day period between initial stratification and post initial visit although there was little difference in eventual improvement at follow-up. Understanding the impact of timing of SBT stratification is indicated. (C) 2014 Elsevier Ltd. All rights reserved.