Yellow Flag Screening/STarT Back Tool

what do psychological factors predict

pain severity, decreased function, more healthcare costs

unidimensional psychological screening tools

FABQ, PCS, PHQ-9, tampa scale of kinesiophobia

multidimensional psychological screening tools

PROMIS, STarT back screening, OSPRO-YF

why are multidimensional screening tools used

they help narrow down what you need to look at to reduce the amount of forms given

risk of prolonged psychological screening

prolonged pt suffering, increase healthcare costs (ex: maybe needed to start graded exposure earlier)

steps of screening process

collect input from stakeholders and choose the tool → administer and interpret results → discuss plan with patient → consult/refer if needed

optimal screening for prediction of referral and outcome yellow flag (OSPRO-YF)

10 item measure that informs about pain disability and general health-related outcomes such as negative mood, fear avoidance, and coping to allow clinician to select additional PROMs to give the patient

STarT back tool

categorizes pt risk of LBP based on presence of modifiable physical/psychological prognostic indicators for persistent and disabling sxs

goal of STarT back tool treatment

directed toward secondary prevention of disabling LBP (prevent it from getting worse)

objectives of STarT back trials

compare effectiveness of subgrouping for targeted treatment, investigate change in prognostic indicators compared to healthy controls

low risk subgroup scoring for STarT back tool

3 or less

medium risk subgroup scoring for STarT back tool

at least for but no more than 3 on Q5-9

high risk subgroup scoring for STarT back tool

4 or more

purpose of modified STarT back tool

reduced to 6 questions for use in MD office to know if they should send the patient to PT

what are questions 5-9 on the STarT back tool

assess psychological risk factors

characteristics of treatment for low-medium risk LBP

assessment, advice, education, back book

characteristics of treatment for high risk LBP

explore impact of biopsychosocial factors on pain and activity, CBT, manage pt expectations and challenge unhelpful thoughts, graded exposure/exercise, prioritize sleep and improving mood, goal setting, support set backs

STarT back tool accuracy compared to expert opinion

formal tool is needed especially when subgrouping pts into the higher risk groups

aspects with long-term improvement after STarT intervention

catastrophizing, fear, depression, general health

benefits of using the STarT back tool

decrease work days lost, healthcare costs, number of unnecessary referrals, increase services offered to medium/high risk pts

when should MD refer pts to PT according to modified STarT tool

3 or more prognostic indicators