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Title: Identifying subgroups among patients with low back pain in primary care: Evaluating the STarT Back Tool
Author: Hill, Jonathan
ISNI:       0000 0001 3578 3605
Awarding Body: Keele University
Current Institution: Keele University
Date of Award: 2008
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Background: Identification of low back pain subgroups has been highlighted as a .priority for secondary prevention of persistent problems in primary care. The aim of this PhD was to develop and evaluate a new clinical tool (called the STarT Back Tool) to allocate patients with back pain into initial treatment subgroups based on treatmentmodifiable prpgnostic indicators. Methods: The setting was, UK primary care adults consulting with non-specific pack ··pain:Constructs that were independent prognostic indicators for persistence were identified from secondary analysis of 2 existing cohorts and published literature and single screening questions identified. Psychometric properties of the tool, including concli.rrent and discriminant validity, internal consistency, repeatabili~y, were assessed . within a 'development' cohort (n=131) and tool score cut-offs established to enable alloc~tion to three subgrOlJPs ('low', 'medium' and 'high' risk). Predictive and ext~rnal . validity were evaluated within an 'independent external' cohort (n=500). The tool was . compared to an existing musculoskeletal screening tool (Orebro Musr:;uloskeletal Pain Screening Questionnaire) and to clinical acumen using video taped clinical interviews, . reviewed by primary care clinical-experts. Finally, the practical application of the tool was tested in. a pilot study and demonstrated to be feasible and acceptable to both . patients and clinicians. Results: The Tool included nine items: referred leg pain; comorbid pain; disability (two items); bothersomeness; catastr~phising; fear; anxiety, and depression. The latter 5 items were identified as a psychosocial subscale. The Tool demonstrated good reliability and validity and was acceptable to patients and clinicians. Conclusions: Identifying treatment subgroups with distinct clinical characteristics among patients in primary care presenting low back pain is pospible and feas'ible in clinical practic~. The tool shows potential for enabling early targeted interventions for the prevention of persistent disabling back problems.
Supervisor: Not available Sponsor: Not available
Qualification Name: Keele University, 2008 Qualification Level: Doctoral
EThOS ID:  DOI: Not available