1/22/2016. STarT BACK TOOL. STarT Back Tool. Psychologically Informed Physical Therapy Practice: Pragmatic Application for Low Back Pain
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1 Jason Beneciuk, PT, PhD, MPH Research Assistant Professor University of Florida Brooks PHHP Research Collaboration Psychologically Informed Physical Therapy Practice: Pragmatic Application for Low Back Pain Jason Beneciuk, PT, PhD Research Assistant Professor, University of Florida; Brooks Rehabilitation PHHP Research Collaboration Carol M. Greco, PhD Assistant Professor of Psychiatry Licensed Psychologist University of Pittsburgh School of Medicine Steven George, PT, PhD Associate Professor DPT Program Director, University of Florida; Brooks Rehabilitation PHHP Research Collaboration Learning Module STarT BACK TOOL 1
2 Subgroups for Targeted Treatment (STarT) Back Screening Tool Thinking about the last 2 weeks tick your response to the following questions: Disagree Agree My back pain has spread down my leg(s) at some time in the last 2 weeks 2 I have had pain in the shoulder or neck at some time in the last 2 weeks 3 I have only walked short distances because of my back pain 4 In the last 2 weeks, I have dressed more slowly than usual because of back pain 5 It s not really safe for a person with a condition like mine to be physically active 6 Worrying thoughts have been going through my mind a lot of the time 7 I feel that my back pain is terrible and it s never going to get any better 8 In general I have not enjoyed all the things I used to enjoy 9 Overall, how bothersome has your back pain been in the last 2 weeks? Not at all Slightly Moderately Very much Extremely Total score (all 9): Sub Score (Q5-9): Keele University 01/08/07 Funded by Arthritis Research UK Item Constructs Thinking about the last 2 weeks tick your response to the following questions: 1 My back pain has spread down my leg(s) at some time in the last 2 weeks Leg pain Construct 2 I have had pain in the shoulder or neck at some time in the last 2 weeks Co-morbid pain 3 I have only walked short distances because of my back pain Disability (walking) 4 In the last 2 weeks, I have dressed more slowly than usual because of back pain Disability (dressing) 5 It s not really safe for a person with a condition like mine to be physically active Pain related fear 6 Worrying thoughts have been going through my mind a lot of the time Anxiety 7 I feel that my back pain is terrible and it s never going to get any better Pain catastrophizing 8 In general I have not enjoyed all the things I used to enjoy Depressive symptoms 9 Overall, how bothersome has your back pain been in the last 2 weeks? Bothersomeness Not at all Slightly Moderately Very much Extremely Total score (all 9): Sub Score (Q5-9): Keele University 01/08/07 Funded by Arthritis Research UK 2
3 Scoring System Total score 3 or less 4 or more Sub score Q5-9 3 or less 4 or more Low Risk Medium Risk High Risk Risk for persistent LBP related disability Keele University 01/08/07 Funded by Arthritis Research UK Risk Groups Low Risk Few physical and/or psychological factors present Medium Risk Physical and psychological factors present; psychological factors are not high High Risk High level of psychological factors present; with or without physical factors RESEARCH FINDINGS 3
4 Convergent Validity SBT Risk Dependent Relationships (Low < Medium < High) Primary care Outpatient PT Pain intensity Disability Physical impairment Not reported Fear avoidance beliefs (PA) Not reported Intake Fear avoidance beliefs (W) Not reported Pain catastrophizing Pain related fear Depressive symptoms Anxiety Not reported Relevant References Example 4
5 Predictive Validity SBT Risk Dependent Relationships (Low < Medium < High) Primary care Outpatient PT Pain intensity Disability Recovery Not reported Treatment was not standardized or guided by STarT Back risk Relevant References Example Matched treatment was not provided 5
6 : Clinical Implications Screening potential across different practice settings Convergent validity for pain intensity, disability, and psychological scores at intake Predictive validity for disability scores and recovery status at 6-months 1. Identify patient subgroups 2. Provide targeted treatment? THANK YOU Brooks-PHHP Research Collaboration 6
1/22/2016 PATIENT SUBGROUPING. Patient Subgrouping. Psychologically Informed Physical Therapy Practice: Pragmatic Application for Low Back Pain
Patient Subgrouping Jason Beneciuk, PT, PhD, MPH Research Assistant Professor University of Florida Brooks Rehabilitation PHHP Research Collaboration Psychologically Informed Physical Therapy Practice:
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