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STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients
Author(s) -
Rabey Martin,
Kendell Michelle,
Godden Chris,
Liburd Jermaine,
Netley Hayley,
O’Shaughnessy Ciaran,
O’Sullivan Peter,
Smith Anne,
Beales Darren
Publication year - 2019
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1351
Subject(s) - medicine , subgroup analysis , sensory system , low back pain , audiology , repeated measures design , physical medicine and rehabilitation , physical therapy , confidence interval , psychology , mathematics , pathology , statistics , alternative medicine , cognitive psychology
Background Investigation of movement and sensory profiles across STarT Back risk subgroups. Methods A chronic low back pain cohort ( n = 290) were classified as low, medium or high risk using the STarT Back Tool, and completed a repeated spinal bending task and quantitative sensory testing. Pain summation, time taken and the number of protective behaviours with repeated bending were measured. Sensory tests included two‐point discrimination, temporal summation, pressure/thermal pain thresholds and conditioned pain modulation. Subgroups were profiled against movement and sensory variables. Results The high‐risk subgroup demonstrated greater pain summation following repeated forward bending ( p < 0.001). The medium‐risk subgroup demonstrated greater pain summation following repeated backward bending ( p = 0.032). Medium‐ and high‐risk subgroups demonstrated greater forward/backward bend time compared to the low‐risk subgroup ( p = 0.001, p = 0.005, respectively). Medium‐ and high‐risk subgroups demonstrated a higher number of protective behaviours per forward bend compared to the low‐risk subgroup ( p = 0.008). For sensory variables, only two‐point discrimination differed between subgroups, with medium‐ and high‐risk subgroups demonstrating higher thresholds ( p = 0.016). Conclusions This study showed altered movement characteristics and sensory discrimination across SBT risk subgroups in people with CLBP. Membership of the high SBT risk subgroup was associated with greater pain and disability levels, greater pain summation following repeated bending, slower bending times, a greater number of protective behaviours during forward bending, and a higher TPD threshold. Treatment outcomes for higher risk SBT subgroups may be enhanced by interventions specifically targeting movement and sensory alterations. Significance In 290 people with chronic low back pain movement profile and two‐point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.