The STarT back tool in chiropractic practice: a narrative review
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REVIEW
Open Access
The STarT back tool in chiropractic practice: a narrative review Yasmeen Khan
Abstract Background: The Keele STarT Back Tool was designed for primary care medical physicians in the UK to determine the risk for persistent disabling pain in patients with musculoskeletal pain and to tailor treatments accordingly. In medical and physical therapy settings, STarT Back Tool’s tailored care plans improved patients’ low back pain outcomes and lowered costs. Objective: Review studies using the STarT Back Tool in chiropractic patient populations. Methods: PubMed, The Cochrane Library, Index to Chiropractic Literature, and Science Direct databases were searched. Articles written in English, published in peer-reviewed journals, that studied the STarT Back Tool in patients seeking chiropractic care were included. Results: Seven articles were selected based on inclusion and exclusion criteria. The STarT Back Tool was feasibly incorporated into 19 chiropractic clinics in Denmark. Total STarT Back 5-item score correlated moderately with total Bournemouth Questionnaire score. Two studies reported that the STarT Back Tool’s predictive ability was poor, while another reported that the tool predicted outcomes in patients scoring in the medium and high risk categories who completed the STarT Back 2 days after their initial visit. A study examining Danish chiropractic, medical and physical therapy settings revealed that only baseline episode duration affected STarT Back’s prognostic ability across all care settings. The tool predicted pain and disability in chiropractic patients whose episode duration was at least 2 weeks, but not in patients with an episode duration 4. This study also described various correlations between elements of the SBT and BQ (Table 2). In the Field and Newell [18] study, baseline SBT score correlated positively with baseline pain score (Numerical Rating Scale and Bournemouth Questionnaire); the low risk group had the lowest pain and disability at baseline while the high-risk group had the highest. However, the outcome differences between the 3 risk groups receiving chiropractic care disappeared by 30 days follow up. By the 30-day follow-up, the high risk group had improved so substantially that there was no longer a statistically significant difference between their outcomes and those in the low and medium risk groups. The Newell et al. [20] study reported that the SBT was prognostic of future outcomes in medium and high risk patients whose scores were collected 2 days after the initial chiropractic treatment visit, suggesting that the timing of stratification plays a role in the SBTs prognostic ability. Patients in the medium risk groups showed greater improvement than the low and high risk groups at the 14 and 30 day follow ups, but not at the 90 day follow up. One-third of the sample changed SBT risk categories in the 2 days between the initial chiropractic visit and 2 days after the initial visit. The Field and Newell [22] study compared patients who were referred by the National Health
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