RESUMO
Background: The STarT (Subgrouping for Targeted Treatment) Back Screening Tool (SBST) is an established clinical evaluation tool that easily assesses the risk of chronic or refractory low back pain. This study aimed to examine the usefulness of acupuncture in patients with low back pain. Methods: A total of 71 outpatients with low back pain who underwent acupuncture and moxibustion at the Center for Integrative Medicine, Tsukuba University of Technology, between 2019 and 2022 were included in this study, regardless of the specific medical condition causing the pain. Survey items included the SBST and lumbar pain intensity visual analog scale (VAS). Demographic factors and contents of acupuncture treatment were collected from the medical charts. The VAS score 4 weeks after the start of treatment was used as an index of clinical outcome and was analyzed using repeated measures analysis of variance (ANOVA) and hierarchical multiple regression analysis. Results: Classification using the SBST at the first visit resulted in 36, 30, and 15 patients in the low-, medium-, and high-risk groups, respectively. Repeated-measures ANOVA showed statistically significant differences in the mean VAS values with respect to differences in time point (P < 0.01), group (P < 0.01), and interaction (P < 0.05). The VAS values after 4 weeks in the high-risk group were significantly higher than those in the other two groups (both P < 0.01). In the hierarchical multiple regression analysis, with VAS as the dependent variable, the relationship between SBST classification and VAS maintained a significant positive relationship in all models, including adjustments for interaction terms and patients’ background items. A simple slope analysis indicated that this relationship was more evident in patients with lower limb symptoms than in those without symptoms. Conclusion: The SBST could be a simple and useful tool for predicting the clinical outcomes of acupuncture.
RESUMO
Background: Psychosocial factors are not routinely identified in physical therapy assessments, although they can influence the prognosis of patients with low back pain. The "STarT Back Screening Tool" (SBST) questionnaire aids in screening such patients for poor prognosis in the primary care setting and classifies them as high, medium, or low risk based on physical and psychosocial factors. Objectives: This study sought to translate and cross-culturally adapt the SBST to the Brazilian Portuguese language and test the reliability of the Brazilian version. Method: The first stage of the study consisted of the translation, synthesis, and back-translation of the original version of the STSB, including revision by the Translation Group, pretest of the translated version, and assessment by an expert panel. The pre-final Brazilian version was applied to 2 samples comprising 52 patients with low back pain; these patients were of both genders and older than 18 years of age. To assess the instrument's reliability, an additional sample comprising 50 patients was subjected to 2 interviews, and the results were assessed using the quadratic weighted kappa value. The instrument's internal consistency was assessed using Cronbach's alpha (n=105), and the standard error of measurement was also calculated (n=50). Results: Translation and back-translation attained consensus, and only item 6 required changes; the reformulated version was applied to an additional sample comprising 52 individuals who did not report any doubts related to this item. The reliability of the SBST-Brazil was 0.79 (95% confidence interval: 0.63-0.95), the internal consistency was 0.74 for the total score and 0.72 for the psychosocial subscale, and the standard error of measurement was 1.9%. Conclusion: The translated and cross-culturally adapted SBST-Brazil proved to be reliable for screening patients according to their risk of poor prognosis and the presence of ...
Contextualização: Fatores psicossociais não são rotineiramente identificados na avaliação fisioterapêutica e podem influenciar o prognóstico de pacientes com dor lombar. O questionário "STarT Back Screening Tool" (SBST) auxilia na triagem desses pacientes em relação ao risco de mau prognóstico no tratamento primário, considerando fatores físicos e psicossociais, classificando-os em de baixo, médio e alto risco. Objetivos: Traduzir e adaptar transculturalmente o SBST para Língua Portuguesa do Brasil e testar a sua confiabilidade. Método: A primeira etapa consistiu na tradução, síntese, retro-tradução, revisão pelo grupo de tradução, pré-teste e avaliação dos documentos pelo Comitê. A versão pré-final foi aplicada em duas amostras de 52 pacientes cada, com dor lombar, de ambos os sexos e idade acima de 18 anos. Para verificação da confiabilidade intra-avaliador, foram realizadas duas entrevistas em outra amostra de 50 pacientes, e os resultados, analisados pelo Kappa ponderado quadrático. Também foram calculados a consistência interna, por meio do Alfa de Cronbach (n=105), e o erro padrão de medida (n=50). Resultados: O consenso foi atingido na tradução e retrotradução, e apenas o item 6 foi reformulado e reaplicado em outros 52 pacientes, os quais não tiveram dúvida. A confiabilidade foi de 0,79 (95% IC 0,63-0,95), a consistência interna para pontuação total foi de 0,74 e, para a subescala psicossocial, de 0,72, e o erro de padrão da medida foi de 1,9%. Conclusão: O SBST-Brasil traduzido e adaptado culturalmente mostrou-se confiável para triar pacientes em relação ao risco de mau prognóstico de tratamento, levando em consideração fatores psicossociais. .