The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire (original) (raw)
Related papers
Journal of Manipulative and Physiological Therapeutics, 2005
Objective: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). Study Design: Predictive and concurrent validation study. Study Participants and Setting: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. Methods: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. Data Analysis: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. Results: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. Conclusions: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes. (J Manipulative Physiol Ther 2005;28:219-227)
Feasibility of the consultation-based reassurance questionnaire in Danish chiropractic practice
Chiropractic & Manual Therapies
Background: Reassuring information is recommended in clinical guidelines for the treatment of low back pain (LBP), but has not been clearly defined. The Consultation-based Reassurance Questionnaire (CRQ) was developed as a tool for measuring to what extent reassurance is present in back pain consultations and may provide important information about the clinical encounter. Until now the CRQ has only been tested in general practice patients in the UK although many patients with LBP are seen outside of this setting. The objectives of this study were to translate the CRQ into Danish, test its feasibility in chiropractic practice, and determine if CRQ scores were associated with satisfaction with care and perceived pain control. Methods: On the day of the first visit for a LBP episode, patients received an electronic survey including the CRQ. Distributions and completeness of responses on the four subscales of the CRQ (data-gathering, relationship-building, generic reassurance, cognitive reassurance) were assessed, and internal consistency for each subscale calculated as Cronbach's alpha. Outcomes at 2 weeks were; satisfaction with care (5-point Likert scale dichotomised into yes/no) and ability to control pain (0-10). Associations of the CRQ with patient characteristics and outcomes were determined in mixed models to account for dependency of observations within clinics. Results: From 964 patients visiting between November 2016 and October 2017 with new episodes of LBP, 717 completed the CRQ with no more than 1% missing values on any single item. The internal consistency was acceptable for all subscales (0.67-0.86). Scores were generally high, and more so in patients visiting a chiropractor for the first time. All four subscales were positively associated with satisfaction (Odds ratios 1.08-1.23) and generic reassurance was weakly associated with pain control (β = 0.07 [95% CI 0.03-0.11]). Conclusions: The CRQ was feasible for use in a Danish chiropractic setting and scores on all four reassurance subscales related positively to patients' satisfaction. Patients who had visited a chiropractor previously reported slightly lower levels of reassuring information, and it should be explored if this is in accordance with the patients' needs. The potential impact on patient outcomes needs investigation.
Chiropractic & manual therapies, 2014
Depression is an important prognostic factor in low back pain (LBP) that appears to be infrequent in chiropractic populations. Identification of depression in few patients would consequently implicate screening of many. It is therefore desirable to have brief screening tools for depression. The objective of this study was to investigate if one or two items from the Major Depression Inventory (MDI) could be a reasonable substitute for the complete scale. The MDI was completed by 925 patients consulting a chiropractor due to a new episode of LBP. Outcome measures were LBP intensity and activity limitation at 3-months and 12-months follow-up. Single items on the MDI that correlated strongest and explained most variance in the total score were tested for associations with outcome. Finally, the predictive capacity was compared between the total scale and the items that showed the strongest associations with outcome measures. In this cohort 9% had signs of depression. The total MDI was si...
Chiropractic & Manual Therapies, 2011
The STarT back screening tool (SBT) allocates low back pain (LBP) patients into three risk groups and is intended to assist clinicians in their decisions about choice of treatment. The tool consists of domains from larger questionnaires that previously have been shown to be predictive of non-recovery from LBP. This study was performed to describe the distribution of depression, fear avoidance and catastrophising in relation to the SBT risk groups. A total of 475 primary care patients were included from 19 chiropractic clinics. They completed the SBT, the Major Depression Inventory (MDI), the Fear Avoidance Beliefs Questionnaire (FABQ), and the Coping Strategies Questionnaire. Associations between the continuous scores of the psychological questionnaires and the SBT were tested by means of linear regression, and the diagnostic performance of the SBT in relation to the other questionnaires was described in terms of sensitivity, specificity and likelihood ratios. In this cohort 59% were in the SBT low risk, 29% in the medium risk and 11% in high risk group. The SBT risk groups were positively associated with all of the psychological questionnaires. The SBT high risk group had positive likelihood ratios for having a risk profile on the psychological scales ranging from 3.8 (95% CI 2.3 -6.3) for the MDI to 7.6 (95% CI 4.9 -11.7) for the FABQ. The SBT questionnaire was feasible to use in chiropractic practice and risk groups were related to the presence of well-established psychological prognostic factors. If the tool proves to predict prognosis in future studies, it would be a relevant alternative in clinical practice to other more comprehensive questionnaires.
Chiropractic & Osteopathy, 2008
Background: In a previous Swedish study it was shown that it is possible to predict which chiropractic patients with persistent LBP will not report definite improvement early in the course of treatment, namely those with LBP for altogether at least 30 days in the past year, who had leg pain, and who did not report definite general improvement by the second treatment. The objectives of this study were to investigate if the predictive value of this set of variables could be reproduced among chiropractic patients in Finland, and if the model could be improved by adding some new potential predictor variables.
Collecting and predicting patient reported outcomes in chiropractic practice
2016
2 reports a study looking at the impact of this missing information on the generalisability of the overall data collected. Non respondents to an emailed assessment 30 days after starting care were less likely to have had >30 days pain in the last year but were not otherwise significantly different from those returning electronic assessments. In a telephone survey comparing respondents and non respondents, patients global impression of change (PGIC) scores were identical and there was no statistical difference in pain scores. Paper 3 sought to ascertain if patient less likely to do well with chiropractic care could be identified from data routinely collected at baseline in chiropractic practice. Longer duration of symptoms at presentation, females with higher social disability scores and males with more adverse scores for depression were found less likely to describe themselves as much improved a month after starting care. In investigating for a relationship between outcome and co...
2023
Background Databases have become an important tool in understanding trends and correlations in health care by collecting demographic and clinical information. Analysis of data collected from large cohorts of patients can have the potential to generate insights into factors identifying treatments and the characteristics of subgroups of patients who respond to certain types of care. The Care Response (CR) database was designed to capture patientreported outcome measures (PROMs) for chiropractic patients internationally. Although several papers have been published analysing some of the data, its contents have not yet been comprehensively documented. The primary aim of this study was to describe the information in the CR database. The secondary aim was to determine whether there was suitable information available to better understand subgroups of chiropractic patients and responsiveness to care. This would be achieved by enabling correlations among patient demographics, diagnoses, and therapeutic interventions with machine learning approaches. Methods Data in all available fields were requested with no date restriction. Data were collected on 12 April 2022. The output was manually scanned for scope and completeness. Tables were created with categories of information. Descriptive statistics were applied. Results The CR database collects information from patients at the first clinical visit, 14, 30, and 90 days subsequently. There were 32,468 patient responses; 3210 patients completed all fields through the 90 day follow up period. 45% of respondents were male; 54% were female; the average age was 49. There was little demographic information, and no information on diagnoses or therapeutic interventions. We received StartBack, numerical pain scale, patient global impression of change, and Bournemouth questionnaire data, but no other PROMs. Conclusions The CR database is a large set of PROMs for chiropractic patients internationally. We found it unsuitable for machine learning analysis for our purposes; its utility is limited by a lack of demographic information, diagnoses, and therapeutic interventions. However, it can offer information about chiropractic care in general and patient satisfaction. It could form the basis for a useful clinical tool in the future, if reformed to be more accessible to researchers and expanded with more information collected.