Investigation of the STarT Back screening tool in outpatient physical therapy settings

Low back pain (LBP) is a major public health problem representing a significant portion of patients seen in physical therapy (PT) settings where some develop chronic symptoms influenced by psychological factors. The Fear-Avoidance Model of Musculoskeletal Pain consists of individual psychological factors that provide a theoretical explanation as to why chronic pain conditions develop in a minority of those experiencing an acute episode. Currently, there is no standardized psychological screening process to identify these at-risk patients suited for clinicians in busy PT settings. One potential screening method involves measuring the influence of individual psychological constructs with several questionnaires, while an alternative method includes screening for general psychological distress with a single questionnaire. The STarT Back is a 9-item screening tool consisting of functional and psychological items that allocates patients into subgroups (i.e., low, medium, or high risk) describing risk status for future disability and are associated with initial treatment options in primary care settings. The STarT Back was developed and intended for use in primary care settings; however has potential for use in physical therapy settings.;This study included 146 patients seeking PT for LBP that completed a battery of measures at initial evaluation and 4-weeks later. Results indicated that the STarT Back was consistent at differentiating patients based on severity of LBP at initial evaluation but not as consistent for predicting 4-week treatment outcomes. Furthermore, an individual Fear-Avoidance Model psychological measure (FABQ-PA) was useful in predicting which patients maintained STarT Back high risk status following 4-weeks of PT treatment for LBP.;The primary limitation to this study was that PT treatment was not tailored to address LBP associated psychological factors. This study provides preliminary evidence that a brief psychological screening tool maybe useful in distinguishing severity of LBP, but may have limited ability to predict 4-week treatment outcomes. (Full text of this dissertation may be available via the University of Florida Libraries web site. Please check http://www.uflib.ufl.edu/etd.html ).