The STarT Back Screening Tool: The Nepali Translation, Cross-Cultural Adaptation and Measurement Properties in Adults With Non-Specific Low Back Pain

Riju Maharjan; Sunee Bovonsunthonchai; Roongtiwa Vachalathiti; Ritu Basnet; Anupa Pathak; Jonathan Hill; Saurab Sharma

doi:10.1002/msc.1952

The STarT Back Screening Tool: The Nepali Translation, Cross-Cultural Adaptation and Measurement Properties in Adults With Non-Specific Low Back Pain

Musculoskeletal Care. 2024 Dec;22(4):e1952. doi: 10.1002/msc.1952.

Authors

Riju Maharjan¹, Sunee Bovonsunthonchai¹, Roongtiwa Vachalathiti¹, Ritu Basnet², Anupa Pathak³, Jonathan Hill⁴, Saurab Sharma^{5

6

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Affiliations

¹ Faculty of Physical Therapy, Mahidol University, Salaya, Thailand.
² Department of Psychiatry and Mental Health, Maharjgunj Medical Campus, T.U. Institute of Medicine, Maharajganj, Nepal.
³ School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁴ School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK.
⁵ Michael J Cousins Pain Management and Research Centre, Royal North Shore Hospital, Sydney, Australia.
⁶ School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
⁷ Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

PMID: 39389933
DOI: 10.1002/msc.1952

Abstract

Introduction/objective: The STarT Back Screening Tool (SBST) stratifies low back pain (LBP) patients based on their risk of chronicity to guide treatment accordingly. The absence of its validated Nepali version limits stratified LBP care in Nepal. The study aimed to translate and cross-culturally adapt the SBST into Nepali and evaluate its measurement properties in adults with LBP.

Methods: The measurement properties of the Nepali SBST were evaluated in 102 Nepali adults with non-specific LBP. We assessed content validity, internal consistency, test-retest reliability, construct and discriminant validity. Item redundancy was evaluated using Cronbach's alpha (α > 0.90), test-retest reliability using Intraclass Correlation Coefficient (ICC_2,1) and Cohen's kappa using established cutoffs score for categorising patients into risk groups, construct validity using hypothesis testing (if a minimum of 75% of the hypotheses were supported), and discriminant validity using Area Under the Curve (AUC) with the reference scales administered at baseline.

Results: Cronbach's alpha scores were 0.72 for the overall scale and 0.66 for the psychosocial subscale. Test-retest reliability values were good to excellent with ICC_2,1 of 0.94 (95% CI: 0.87-0.97) for the overall scale and 0.87 (95% CI: 0.73-0.94) for the psychosocial subscale and Kappa values of 0.68 (95% CI: 0.43-0.93) for the overall scale and 0.79 (95% CI: 0.52-1.00) for psychosocial subscale. Construct validity was confirmed as 100% of a priori hypotheses were met. Acceptable discriminative validity was observed with reference scales with AUCs (0.75-0.80).

Conclusions: Nepali SBST demonstrates the reliability and validity of screening for chronicity risk in Nepali adults with LBP. Future studies should evaluate its responsiveness, predictive abilities, and effectiveness in stratifying LBP patients in the Nepalese context.

Keywords: STarT back screening tool; cross‐cultural adaptation; low back pain; measurement properties; musculoskeletal pain; reliability; validity.

MeSH terms

Adult
Cross-Cultural Comparison
Female
Humans
Low Back Pain* / diagnosis
Male
Middle Aged
Nepal
Pain Measurement
Reproducibility of Results
Surveys and Questionnaires / standards
Translations*