Psychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted.
The purpose of this study was to test the predictive validity of the STarT Back Screening Tool (SBT) in comparison to single-construct psychological measures for 6-month clinical outcomes.
Observational, prospective cohort study.
Patients (n = 146) receiving physical therapy for LBP were administered the SBT and a battery of psychological measures (Fear-Avoidance Beliefs Questionnaire (physical activity scale – FABQ-PA; work scale – FABQ-W); Pain Catastrophizing Scale – PCS; Tampa Scale of Kinesiophobia – TSK-11; and Patient Health Questionnaire – PHQ-9) at initial evaluation and 4-weeks later. Treatment was at the physical therapist's discretion. Clinical outcomes consisted of pain intensity and self-reported disability. Prediction of 6-month clinical outcomes was assessed for intake SBT and psychological measure scores using multiple regression models while controlling for other prognostic variables. In addition, we assessed the predictive capabilities of intake to 4-week changes in SBT and psychological measure scores for 6-month clinical outcomes.
Intake pain intensity (β = .39 to .45) and disability (β = .47 to .60) scores were the strongest predictors in all final regression models explaining 22% and 24% and 43% and 48% of the variance for the respective clinical outcome at 6-months. Neither SBT nor psychological measure scores improved prediction of 6 month pain intensity. SBT overall (β = .22) and SBT psychosocial (β =.25) scores added to the prediction of disability at 6-months. Four-week changes in TSK-11 scores (β = –.18) were predictive of pain intensity at 6-months. Four-week changes in FABQ-PA (β = –.21), TSK-11 (β = –.20) and SBT overall (β = –.18) scores were predictive of disability at 6-months.
Physical therapy treatment was not standardized or accounted for in the analysis.
Prediction of clinical outcomes by psychology-based measures was dependent on the clinical outcome domain of interest. Similar to studies from the primary care setting, initial screening with the SBT provided additional prognostic information for 6-month disability and changes in SBT overall scores may provide important clinical decision-making information for treatment monitoring. In comparison to the SBT, individual psychological measures (i.e., TSK-11 and FABQ-PA) may potentially be more appropriate for treatment monitoring.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120207v1?rss=1
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