Comparing the responsiveness of a brief, multidimensional risk screening tool for back pain to its unidimensional reference standards: the whole is greater than the sum of its parts

Pain. 2012 Nov;153(11):2182-2191. doi: 10.1016/j.pain.2012.06.010. Epub 2012 Jul 15.


Back pain is a leading cause of disability. Previous research suggests that modifiable risk factors influence recovery from back pain, and practice guidelines recommend integrating such factors within primary care management. Toward this goal, a brief, multidimensional questionnaire, the STarT Back Tool, was designed to facilitate risk assessment by reducing the need to administer multiple, unidimensional questionnaires. However, aspects of this tool's clinical utility remain unaddressed. For instance, it is unclear whether this tool is responsive to treatment-related changes or whether clinically meaningful information is lost when it replaces multiple risk questionnaires. This study compared the responsiveness of the STarT Back Tool to its corresponding full-length measures, and evaluated its ability to detect clinically meaningful improvement. The study sample included 300 participants that consulted their doctor with disabling back pain. The STarT Back Tool and its reference standard questionnaires (disability, catastrophizing, fear, and depression) were administered at baseline and 4 months later. Regression analyses tested whether, after controlling for its reference standard questionnaires, the STarT Back Tool (independent variable) predicted treatment-related changes in global improvement, pain severity, disability, catastrophizing, fear, and depression (dependent variables). Receiver operating characteristic analyses determined the level of STarT Back change needed for clinically meaningful improvement. STarT Back scores predicted changes in all dependent variables except depression. Reductions in STarT Back scores predicted meaningful improvement on all dependent variables. These findings suggest that the STarT Back Tool, instead of multiple risk questionnaires, can be used to measure recovery from back pain. Implications for future research and clinical practice are discussed.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / diagnosis*
  • Low Back Pain / epidemiology
  • Low Back Pain / therapy
  • Male
  • Middle Aged
  • Pain Measurement / methods*
  • Pain Measurement / standards*
  • Predictive Value of Tests
  • Primary Health Care / methods
  • Reproducibility of Results
  • Risk Factors
  • Single-Blind Method
  • Surveys and Questionnaires / standards*
  • Treatment Outcome