Skip to main content

Research Repository

Advanced Search

Refinement and validation of a tool for stratifying patients with musculoskeletal pain

Dunn, Kate M.; Campbell, Paul; Lewis, Martyn; Hill, Jonathan C.; van der Windt, Danielle A.; Afolabi, Ebenezer; Protheroe, Joanne; Wathall, Simon; Jowett, Sue; Oppong, Raymond; Mallen, Christian D.; Hay, Elaine M.; Foster, Nadine E.

Refinement and validation of a tool for stratifying patients with musculoskeletal pain Thumbnail


Authors

Ebenezer Afolabi

Sue Jowett

Raymond Oppong

Nadine E. Foster



Abstract

AbstractBackgroundPatients with musculoskeletal pain in different body sites share common prognostic factors. Using prognosis to stratify and treatment match can be clinically and cost‐effective. We aimed to refine and validate the Keele STarT MSK Tool for prognostic stratification of musculoskeletal pain patients.MethodsTool refinement and validity was tested in a prospective cohort study, and external validity examined in a pilot cluster randomized controlled trial (RCT). Study population comprised 2,414 adults visiting U.K. primary care with back, neck, knee, shoulder or multisite pain returning postal questionnaires (cohort: 1,890 [40% response]; trial: 524). Cohort baseline questionnaires included a draft tool plus refinement items. Trial baseline questionnaires included the Keele STarT MSK Tool. Physical health (SF‐36 Physical Component Score [PCS]) and pain intensity were assessed at 2‐ and 6‐month cohort follow‐up; pain intensity was measured at 6‐month trial follow‐up.ResultsThe tool was refined by replacing (3), adding (3) and removing (2) items, resulting in a 10‐item tool. Model fit (R2) was 0.422 and 0.430 and discrimination (c statistic) 0.839 and 0.822 for predicting 6‐month cohort PCS and pain (respectively). The tool classified 24.9% of cohort participants at low, 41.7% medium and 33.4% high risk, clearly discriminating between subgroups. The tool demonstrated model fit of 0.224 and discrimination 0.73 in trial participants. Multiple imputation confirmed robustness of findings.ConclusionsThe Keele STarT MSK Tool demonstrates good validity and acceptable predictive performance and clearly identifies groups of musculoskeletal pain patients with different characteristics and prognosis. Using prognostic information for stratification and treatment matching may be clinically/cost‐effective.SignificanceThe paper presents the first musculoskeletal pain prognostic stratification tool specifically for use among all primary care patients with the five most common musculoskeletal pain presentations (back, neck, knee, shoulder or multisite pain). The Keele STarT MSK Tool identifies groups of musculoskeletal pain patients with clearly different characteristics and prognosis. Using this tool for stratification and treatment matching may be clinically and cost‐effective.

Journal Article Type Article
Acceptance Date Jun 4, 2021
Online Publication Date Jul 3, 2021
Publication Date Jun 8, 2021
Publicly Available Date Mar 29, 2024
Journal European Journal of Pain
Print ISSN 1090-3801
Publisher Wiley
Volume 25
Issue 10
Pages 2081-2093
DOI https://doi.org/10.1002/ejp.1821
Keywords Anesthesiology and Pain Medicine
Publisher URL https://onlinelibrary.wiley.com/doi/10.1002/ejp.1821
PMID 34101299