Translation and validation of ‘the STarT Back Tool’

This project: translated the The STarT Back screening Tool (SBT) into Danish, tested its concurrent validity, quantified its predictive validity in Danish primary care, investigated differences in psychosocial characteristics between Danish primary and secondary care settings, and quantified its predictive validity in a Danish secondary care setting. Lars Morsøs Ph.d.-afhandling fra 2013 (afhandlingen er på engelsk).



Læs afhandlingen
Kontakt Lars Morsø
Lars Morsø på Fag og Forsknings ph.d.-liste

Summary af Lars Morsø

Introduction

The STarT Back screening Tool (SBT) is a nine-item patient self-report questionnaire for triage of non-specific low back pain patients in primary care. This short multidimensional questionnaire identifies modifiable risk factors such as pain, activity limitation and psychosocial constructs, and its three-level classification (low, medium, high risk of poor outcome) has prognostic and treatment implications. This project: (i) translated the SBT into Danish, (ii) tested its concurrent validity, (iii) quantified its predictive validity in Danish primary care, (iv) investigated differences in psychosocial characteristics between Danish primary and secondary care settings, and (v) quantified its predictive validity in a Danish secondary care setting.

Methods

The translation was performed using methods recommended by international guidelines, and the concurrent validity of the questionnaire was performed cross-culturally using Danish and UK datasets. The predictive validity of the SBT in primary care was described and compared crossculturally also using data from Danish and UK primary care. Differences in psychosocial characteristics and secondary care predictive validity were studies using data from Danish primary and secondary care.

Results

The Danish SBT translation was linguistically accurate and, despite differences found in the performance of the psychosocial sub-scale, the resultant version of the SBT had sufficient patient acceptability and discriminative validity to be used in Denmark. The predictive ability of the low- and- medium-risk SBT subgroups in Danish primary care was similar to that in UK primary care but was slightly reduced in the high-risk group in DK primary care.

What was known prior to this PhD project?
· The SBT can identify modifiable risk factors in primary care.
· The SBT can classify patients into relevant subgroups.
· The SBT has prognostic and treatment implications.
· The targeting of treatment has been shown to have positive
clinical effectiveness and economic impact.

What does this PhD project add?
· The Danish translation of SBT was linguistically accurate and acceptable to patients.
· The discriminative validity of SBT was acceptable.
· The predictive ability in primary care was acceptable.
· The predictive ability of SBT in secondary care was less.


The comparison of patient psychosocial profiles across Danish primary and secondary care settings showed significantly higher movement-related fear and catastrophisation in secondary care but lower anxiety. However, the size of these differences was unlikely to be clinically important.

Testing of the SBT predictive validity in secondary care showed it was less able to predict poor outcome at 6-month follow-up in a Danish secondary care setting than in a Danish primary care setting.

Conclusion

Collectively, the results from these studies on the translation, discriminative validity and predictive validity of the Danish SBT indicate that it is suitable as a triage tool in primary care. Although there were no clinically important differences in the psychosocial profile of patients between primary and secondary care, the predictive ability of the SBT classification subgroups was weaker in Danish secondary care which there may be many reasons for.

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