CROSS-CULTURAL ADAPTATION OF THE START BACK SCREENING TOOL IN A GREEK LOW BACK PAIN SAMPLE

E. Billis¹, M. Tsekoura¹, S. Lampropoulou¹, S. Xergia¹, T. Bania¹, C. Matzaroglou¹, K. Fousekis¹, J. Hill², N. Strimpakos³

Background: The Keele STarT Back Screening Tool (SBST) is a popular 9-item questionnaire, with validation studies in several cultural settings, but not Greek. It is designed to screen primary care patients with low back pain (LBP) for prognostic indicators for recovery by classifying them into one of three prognostic categories (low risk, medium or high risk) of which different clinical decisions are being recommended.

Purpose: The cross-cultural adaptation and validation of the SBST into Greek among patients with LBP and LBP-associated leg pain.

Methods: The cross-cultural translation was completed through five-stages of forward and back-translation by 4 bi-lingual translators. The validation study involved administering the adapted Greek SBST to LBP and sciatica patients who consented for participation whistle in their first attendance to physiotherapy outpatients. Patients also completed a set of other validated measures adapted into Greek; Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Short-form Health Survey (SF-12), Sciatica Bothersomeness Index (SBI), numeric pain rating scale (NPRS) for worst pain intensity, and body chart pain location sites. Measurement properties were explored including internal consistency, content, construct and discriminatory validity. Test-retest reliability was explored by re-administering SBST after 7-10 days across patients whose symptoms remained unchanged.

Results: 124 patients (75 females, 49.1±14.2 years-old), 43.5% of whom had sciatica completed SBST. Greek SBST was successfully developed. No floor or ceiling effects were detected and mean score distributions across the three SBST prognostic groups (low, medium and high risk) were statistically different. Moderate to strong correlations were found for SBST (total and psychosocial scores) with RMDQ, SBI, HADS and SF-12 (Spearman’s ρ=0.423-0.602). Most associations between individual SBST items and reference standards (RMDQ, SBI, HADS, SF-12) were moderately correlated (ρ=0.316-0.486). Greek SBST yielded acceptable discriminant validity with RMDQ (AUC of 0.804) but not with HADS. Individual items (1,3,4,9) yielded acceptable discrimination against reference standards, whereas, items 5, 6, 7 and 8 were below 0.7, indicating poor discrimination. Test-retest reliability, explored in a smaller patient sample was very good (ICC3,2=0.930, SEM=0.532, SDD=54.61%). Test-retest reliability explored in a smaller patient sample was satisfactory for total score (ICC3,2=0.930, SEM=0.532, SDD=54.61%) and individual items (kappa=0.587-0.881). Cronbach’s α was also good (0.705 for total and 0.757 for psychosocial score).

Conclusion(s): The Greek SBST was proven to be appropriate, comprehensible, valid and reliable for the LBP sample tested and may thus, be used in cross-cultural rehabilitation research and clinical practice across Greek LBP and LBP-leg associated pain patients.

Implications: The Greek SBST is recommended for evaluation and prognostic purposes of Greek patients in cross-cultural rehabilitation research and clinical practice. Further research is needed to explore its prognostic and clinical decision-making ability across a larger patient sample.

Funding, acknowledgements: None

Keywords: STarT Back Screening Tool, cross-cultural adaptation, Greek

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Technological Educational Institute (T.E.I.) of Western Greece

Committee: Comittee of the School of Health and Caring Professions

Ethics number: 201905/4-11-2019