Evaluation of Cross-Cultural Adaptation and Measurement Properties of STarT Back Screening Tool: A Systematic Review

Fadi M. Al Zoubi, Owis Eilayyan, Nancy E. Mayo, André E. Bussières (Corresponding Author)

Research output: Journal article publicationReview articleAcademic researchpeer-review

10 Citations (Scopus)


Objective The purpose of this systematic review was to investigate the extent to which the STarT Back Screening Tool (SBST) has been evaluated for (1) the quality of translation of evidence for cross-cultural adaptation and (2) the measurement properties in languages other than English. Methods A systematic search of 8 databases, including Medline, Embase, CINAHL, PsycINFO, AMED, Scopus, PubMed, and Web of Science, was performed. Electronic databases were searched for the period between 2008 and December 27, 2016. We included studies related to cross-cultural adaptation, including translation and assessment of the measurement properties of SBST. Study selection, translation, methodologic and quality assessments, and data extraction were performed independently by 2 reviewers. Results Of the 1566 citations retrieved, 17 studies were admissible, representing 11 different SBST versions in 10 languages. The quadratic weighted κ statistics of the 2 reviewers, for the translation, methodologic assessment, and quality assessment were 0.85, 0.76, and 0.83, respectively. For translation, only 2 versions (Belgian-French and Mandarin) fulfilled all requirements. None of the versions had tested all the measurement properties, and when performed, these were found to have been conducted inadequately. With regard to quality assessment, overall, the included versions had a “Poor” total summary score except 2 (Persian and Swiss-German), which were rated as “Fair.” Conclusions Few versions fully met the standard criteria for valid translation, and none of the versions tested all the measurement properties. There is a clear need for more accurate cross-cultural adaptation of SBST and greater attention to the quality of psychometric evaluation of the adapted versions of SBST. At this time, caution is recommended when using SBST in languages other than English.

Original languageEnglish
Pages (from-to)558-572
Number of pages15
JournalJournal of Manipulative and Physiological Therapeutics
Issue number8
Publication statusPublished - Oct 2017
Externally publishedYes


  • Communication Barriers
  • Low Back Pain
  • Outcome Assessment (Health Care)
  • Patient Reported Outcome Measures
  • Review

ASJC Scopus subject areas

  • Chiropractics

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