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Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care
  1. Malin H Forsbrand1,2,
  2. Birgitta Grahn1,3,
  3. Jonathan C Hill4,
  4. Ingemar F Petersson1,5,
  5. Charlotte Post Sennehed1,3,
  6. Kjerstin Stigmar5,6
  1. 1 Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
  2. 2 Blekinge Centre of Competence, Landstinget Blekinge, Karlskrona, Sweden
  3. 3 Department of Research and Development, Region Kronoberg, Växjö, Sweden
  4. 4 Research Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
  5. 5 Skåne University Hospital, Lund, Sweden
  6. 6 Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
  1. Correspondence to Malin H Forsbrand; malin.forsbrand{at}


Objectives The predictive ability of the STarT Back Tool (SBT) has not yet been examined among acute/subacute back and/or neck pain in a primary care setting in respect to health-related quality of life (HRQoL) and work ability outcomes. The aim of this study was to evaluate the SBT’s predictive validity for HRQoL and work ability outcomes at long-term follow-up in a population with acute/subacute back and/or neck pain.

Setting Prospective data from 35 primary care centres in south Sweden during 2013.

Participants Patients (n=329) with acute/subacute back and/or neck pain, aged 18–67 years, not on sick leave or <60 days of sick leave completed the SBT when applying for physiotherapy treatment. Long-term follow-up measures (median 13 months, range 11–27 months) of HRQoL (EQ-5D) and work ability (Work Ability Score) was completed by 238 patients (72%).

Outcomes The predictive ability of the SBT for HRQoL and work ability outcomes was examined using Kruskal-Wallis test, logistic regression and area under the curve (AUC).

Results Based on SBT risk group stratification, 103 (43%), 107 (45%) and 28 (12%) patients were considered as low, medium and at high risk, respectively. There were statistically significant differences in HRQoL (p<0.001) and work ability (p<0.001) at follow-up between all three SBT risk groups. Patients in the high risk group had a significantly increased risk of having poor HRQoL (OR 6.16, 95% CI 1.50 to 25.26) and poor work ability (OR 5.08, 95% CI 1.75 to 14.71) vs the low risk group at follow-up. The AUC was 0.73 (95% CI 0.61 to 0.84) for HRQoL and 0.68 (95% CI 0.61 to 0.76) for work ability.

Conclusions The SBT is an appropriate tool for identifying patients with a poor long-term HRQoL and/or work ability outcome in a population with acute/subacute back and/or neck pain, and maybe a useful adjunct to primary care physiotherapy assessment and practice.

Trial registration number NCT02609750; Results.

  • STarT Back Tool
  • health related quality of life
  • work ability
  • primary care
  • back pain
  • neck pain

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  • Contributors All authors discussed the results and commented on the manuscript. MF, IP, KS and BG were responsible for the study design, data analysis and interpretation. MF, BG and KS prepared and validated data. MF collected data and drafted the manuscript. JH and CPS took part in study design, data analysis and interpretation of data. All authors read and approved the final version of the manuscript.

  • Funding This work was supported by The Scientific Committee of Blekinge County Council, Sweden (Dnr 2017-00686) and the County Councils Region Skåne, Kronoberg and Blekinge, REHSAM research, Sweden (RS2011/005).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Regional Ethical Review Board in Lund, Sweden (Dnr 2012/497, 2013/426, Dnr 2015/214).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets analysed during the current study are available from the corresponding author on reasonable request.