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Tan C1,2, Liaw J2, Jiang B1, Pothiawala SE3, Li H4, Leong M3
1Singapore Health Services, Group Allied Health, Singapore, Singapore, 2Singapore General Hospital, Physiotherapy Department, Singapore, Singapore, 3Singapore General Hospital, Department of Emergency Medicine, Singapore, Singapore, 4Singapore General Hospital, Health Services Research Unit, Singapore, Singapore
Background: Low back pain (LBP) constitutes a challenging health problem which causes considerable socio-economic burden to healthcare system globally. Efforts have been focused on early prognostic assessment and stratification of LBP patients to match interventions. Recently, the STarT Back Screening Tool (SBT) for back pain prognostic indicators has been developed to help initial decision making in primary care settings and has shown clinical and economic benefits.
Purpose: In this study, we aim to investigate whether the SBT could provide prognostic information for long-term clinical outcomes of acute LBP patients visiting the emergency department (ED) of a tertiary hospital in Singapore, who might benefit from appropriate and timely management at an earlier stage.
Methods: A prospective observational cohort study was conducted. Eligible patients consulting ED doctors with acute LBP were invited to participate and administered the SBT at initial evaluation. Demographic information and LBP-related clinical characteristics were either gathered from patients' case notes or self-reported by patients via telephone interview. The clinical outcome was pain score which was collected at baseline, 6-week and 6-month follow-up measured using numeric pain rating scale. Treatments or referrals of patients were at the discretion of ED doctors in line with current best practice and guidelines in Singapore. Prediction of pain score at 6-month was evaluated by using a multiple linear regression model which was constructed through backward selection of candidate predictors (SBT total and psychosocial scores, age, gender, employment status, LBP history, LBP symptom duration, 6-week pain score).
Results: A total of 200 eligible patients were recruited, of which 23 patients were excluded from analysis due to loss of contact or refusal to participate further. Of the 177 participants, the mean age was 41.3 years (SD=14.2 years) and there were 110 (62.1%) males. The mean SBT total and psychosocial scores were 4.6 (SD=2.1) and 2.6 (SD=1.5) respectively. In the multiple linear regression analysis, SBT psychosocial score lost predictive power, while SBT total score was identified as a significant predictor (p 0.05) with coefficient of 0.125. Other variables which remained as independent predictors in the multiple linear regression model were age, employment status, LBP history, and 6-week pain score. Among all variables in the final model, 6-week pain score was found to be the strongest predictor for 6-month pain score with coefficient of 0.500. The model achieved R2 of 0.418 and adjusted R2 of 0.401.
Conclusion(s): A regression model built by integrating SBT total score, patient demographics and short-term pain score has shown predictive value in determining long-term pain for acute LBP patients presenting to the ED.
Implications: This study implied that SBT has the potential to provide prognostic information for LBP patients in the emergency care settings.
Keywords: STarT Back Screening Tool, emergency department, low back pain
Funding acknowledgements: This study was supported by the Singapore General Hospital Research Grant (No. SRG/C1/09/2014).
Purpose: In this study, we aim to investigate whether the SBT could provide prognostic information for long-term clinical outcomes of acute LBP patients visiting the emergency department (ED) of a tertiary hospital in Singapore, who might benefit from appropriate and timely management at an earlier stage.
Methods: A prospective observational cohort study was conducted. Eligible patients consulting ED doctors with acute LBP were invited to participate and administered the SBT at initial evaluation. Demographic information and LBP-related clinical characteristics were either gathered from patients' case notes or self-reported by patients via telephone interview. The clinical outcome was pain score which was collected at baseline, 6-week and 6-month follow-up measured using numeric pain rating scale. Treatments or referrals of patients were at the discretion of ED doctors in line with current best practice and guidelines in Singapore. Prediction of pain score at 6-month was evaluated by using a multiple linear regression model which was constructed through backward selection of candidate predictors (SBT total and psychosocial scores, age, gender, employment status, LBP history, LBP symptom duration, 6-week pain score).
Results: A total of 200 eligible patients were recruited, of which 23 patients were excluded from analysis due to loss of contact or refusal to participate further. Of the 177 participants, the mean age was 41.3 years (SD=14.2 years) and there were 110 (62.1%) males. The mean SBT total and psychosocial scores were 4.6 (SD=2.1) and 2.6 (SD=1.5) respectively. In the multiple linear regression analysis, SBT psychosocial score lost predictive power, while SBT total score was identified as a significant predictor (p 0.05) with coefficient of 0.125. Other variables which remained as independent predictors in the multiple linear regression model were age, employment status, LBP history, and 6-week pain score. Among all variables in the final model, 6-week pain score was found to be the strongest predictor for 6-month pain score with coefficient of 0.500. The model achieved R2 of 0.418 and adjusted R2 of 0.401.
Conclusion(s): A regression model built by integrating SBT total score, patient demographics and short-term pain score has shown predictive value in determining long-term pain for acute LBP patients presenting to the ED.
Implications: This study implied that SBT has the potential to provide prognostic information for LBP patients in the emergency care settings.
Keywords: STarT Back Screening Tool, emergency department, low back pain
Funding acknowledgements: This study was supported by the Singapore General Hospital Research Grant (No. SRG/C1/09/2014).
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: Singapore Health Services
Ethics committee: Centralised Institutional Review Board
Ethics number: 2013/603/F
All authors, affiliations and abstracts have been published as submitted.
