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Forsbrand M.H.1,2,3, Grahn B.1,3,4, Hill J.C.5, Petersson I.F.1, Post Sennehed C.1,3,4, Stigmar K.3,6
1Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden, 2Blekinge Centre of Competence, Landstinget Blekinge, Karlskrona, Sweden, 3Epidemiology and Register Centre South, Region Skåne, Lund, Sweden, 4Region Kronoberg, Department of Research and Development, Växjö, Sweden, 5Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom, 6Physical Therapy, Department of Health Sciences, Lund, Sweden
Background: Musculoskeletal disorders, especially back and neck pain, are major causes of work disability in the Western world and causes of high costs for society and healthcare. The widely used STarT Back Tool (SBT) is a short risk stratification tool that includes questions on predictors for long-term disabling back pain, in order to match individuals to appropriate targeted treatments, according to their prognostic profile. The SBT classifies patients into three risk groups, based on different needs for treatment; low, medium or high risk. The SBT´s predictive ability regarding health related quality of life and work ability has not yet been tested in a primary care setting for a Swedish study population.
Purpose: To study if SBT´s risk groups predict health related quality of life and work ability in long-term follow-up among patients with acute or subacute back and/or neck pain.
Methods: We conducted a prospective cohort study and the sample identified from a separate clinical trial recruiting from 32 primary care centers in Sweden during 2013. Physical therapy patients within this trial with acute or subacute back and/or neck pain, aged 18-67, not on sick leave or 60 days on sick leave, were asked to complete the SBT (n=330). Patient-reported follow-up outcomes were determined at long-term follow-up (12-27 months) from questionnaires on health related quality of life (HRQoL) using the EQ-5D and work ability using an established Work Ability Score (graded 0-10, where 0 means completely unable to work and 10 means work ability at its best). Poor outcome was defined with a threshold of 0.6 (poor HRQoL) and 8 points (poor work ability) and the proportions with a poor outcome described. The discriminative ability of the SBTs risk groups to predict poor HRQoL and work ability at follow-up were examined using Kruskal-Wallis and Mann-Whitney U tests.
Results: Complete SBT questionnaires were available for 237/330 (72%) patients (median age 46, 67.1% women). The population had 102 low risk patients (43%), 107 (45%) at medium risk, and 28 (12%) at high risk. Median time for follow-up was 13 (11-27) months. The proportion of patients with poor HRQoL was higher in the high risk group (low risk 4%, medium risk 11%, high risk 36%) and for patients with poor work ability we saw the same pattern (23%, 36% and 68%) for each risk group respectively. There were statistically significant differences in HRQoL (p 0.001) and work ability (p 0.01) at follow-up, between all three SBT risk groups.
Conclusion(s): The SBT risk groups demonstrated high predictive abilities in relation to long-term HRQoL and work ability.
Implications: The SBT is an appropriate method to identify patients with a poor long-term HRQoL and reduced work ability, and maybe a useful adjunct to Swedish physical therapy assessment and practice.
Funding acknowledgements: REHSAM Vårdal Foundation (RF11-005) and Blekinge County Council, Sweden (Dnr 015/0036)
Topic: Musculoskeletal: spine
Ethics approval: The study was approved by the Regional Ethical Review Board in Lund, Sweden (Dnr 2012/497, 2013/426 and 2015/214)
All authors, affiliations and abstracts have been published as submitted.
