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The predictive and external validity of the STarT Back Tool in Danish primary care

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Abstract

Purpose

The STarT Back Tool (SBT) was recently translated into Danish and its concurrent validity described. This study tested the predictive validity of the Danish SBT.

Methods

Danish primary care patients (n = 344) were compared to a UK cohort. SBT subgroup validity for predicting high activity limitation at 3 months’ follow-up was assessed using descriptive proportions, relative risks, AUC and odds ratios.

Results

The SBT had a statistically similar predictive ability in Danish primary care as in UK primary care. Unadjusted relative risks for poor clinical outcome on activity limitation in the Danish cohort were 2.4 (1.7–3.4) for the medium-risk subgroup and 2.8 (1.8–3.8) for the high-risk subgroup versus 3.1 (2.5–3.9) and 4.5 (3.6–5.6) for the UK cohort. Adjusting for confounders appeared to explain the lower predictive ability of the Danish high-risk group.

Conclusions

The Danish SBT distinguished between low- and medium-risk subgroups with a similar predictive ability of the UK SBT. That distinction is useful information for informing patients about their expected prognosis and may help guiding clinicians’ choice of treatment. However, cross-cultural differences in the SBT psychosocial subscale may reduce the predictive ability of the high-risk subgroup in Danish primary care.

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Acknowledgments

The authors thank the Danish Quality Unit of General Practice, the GPs and physiotherapists for collecting data, and the research secretaries at the Spine Centre of Southern Denmark and NIKKB for assistance in handling that data. The authors are also grateful for funding received by the Region of Southern Denmark and the University of Southern Denmark.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Services Research, University of Southern Denmark, A Member of the Clinical Locomotion Network, Oestre Hougvej 55, Middelfart, 5500, Denmark

    Lars Morsø, Peter Kent, Hanne B. Albert & Claus Manniche

  2. Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK

    Jonathan C. Hill

  3. Nordic Institute of Chiropractic and Clinical Biomechanics, A Member of the Clinical Locomotion Network, Odense, Denmark

    Alice Kongsted

Authors
  1. Lars Morsø
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  2. Peter Kent
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  3. Hanne B. Albert
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  4. Jonathan C. Hill
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  5. Alice Kongsted
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  6. Claus Manniche
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Corresponding author

Correspondence to Lars Morsø.

Appendix 1. Formation of the Danish primary care cohort

Appendix 1. Formation of the Danish primary care cohort

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Morsø, L., Kent, P., Albert, H.B. et al. The predictive and external validity of the STarT Back Tool in Danish primary care. Eur Spine J 22, 1859–1867 (2013). https://doi.org/10.1007/s00586-013-2690-z

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  • DOI: https://doi.org/10.1007/s00586-013-2690-z

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