Investigation of validity for the STarT Back Screening Tool : – A Systematic Review

Abstract: Background: Non-specific low back pain is a growing problem in society. No treatment have shown satisfying results to reduce pain or disability for patients with non-specific low back pain, and 1-18% of these patients develop chronic low back pain. STarT Back Screening Tool (SBST) is an instrument for sub grouping patients with non-specific low back pain into low, medium or high risk of developing chronic low back pain and then modifying the treatment after the different needs of every patient. The purpose of this study was to do a systematic review, investigating validation of the SBST to evaluate the justification of its use by clinicians. Method: Pubmed, Cinahl and Medline was searched in February 2017 for studies investigating criterion validity, construct validity and content validity of the SBST. The author (JG) assessed risk of bias and extracted relevant data following the procedures of PRISMA-statement. Result: 15 articles were identified for inclusion in the review. 8 articles investigated criterion validity, 11 articles investigated construct validity and 1 article investigated content validity. Predictive validity showed heterogeneous statistical analysis and varying results, a narrative result was presented that showed marginal benefits for the use of SBST for prediction of future outcome. Concurrent validity was measured with Spearman’s rank correlation coefficient in all investigated articles, showing results between 0.34-0.802. Discriminant validity was measured with Area under the curve analysis in all articles, scoring between 0.69-0.92. Convergent validity showed a Pearson’s correlation between 0.708-0.811 and a Spearman’s rank correlation between 0.35-0.74. Conclusion: Because of heterogeneity of the results it is not possible to draw conclusive conclusions. However, results tend to show limited evidence for the use of SBST as a predictive instrument for patients with non-specific low back pain.