STarT Back Screening Tool

Original Editor - Alistair James

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Objective

The Keele STarT Back Screening Tool (SBST) (9-item version) is a brief validated tool, designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making (Keele University n. d.).

Intended Population

Primary care patients with low back pain (Keele University n. d.).

Method of Use

The STarT Back Screening Tool helps primary care clinicans (GPs, physiotherapists etc) to group patients into three categories of risk of poor outcome (persistent disabling symptoms) - low, medium, and high-risk. By being able to categorise patients into these 3 groups, clinicians are then able to target interventions to each sub-group of patients to help outcome (Keele University n.d).

The STarT Back Screening Tool is availalbe in a number of languages including: English, Dutch, French, Spanish, Danish and Welsh (Keele University n.d). The tool produces two scores: overall scores and distress subscale scores (Hill et al. 2008).

• The distress subscale score is used to identify the high-risk subgroup. To score this subscale add the last 5 items; fear, anxiety, catastrophising, depression and bothersomeness (bothersomeness responses are positive for 'very much' or 'extremely' bothersome back pain). Subscale scores range from 0 to 5 with patients scoring 4 or 5 being classified into the high-risk subgroup (Keele University n.d).
• The overall score is used to seperate the low risk patients from the medium-risk subgroups. Scores rnage from 0-9 and are produced by adding all positive items; patients who achieve a score of 0-3 are classified into the low-risk subgroup and those with scores of 4-9 into the medium-risk subgroup (Keele University n.d).

Evidence

The STarT Back trial (Hill et al. 2011) compared the clinical and cost effectivness of stratified management approach; allocating patients to different treatment pathways based on thier prognosis (low, medium, or high risk of poor outcome); with that of current best practice. The trial demonstrated that this new model results in greater health benefits, achieved at a lower average health-care cost, with an average saving to health services of £34.39 per patient and societal savings of £675 per patient (Keele University n.d).

Links

Keele STarT Back Screening Tool website: http://www.keele.ac.uk/sbst/

Download the Tool: http://www.keele.ac.uk/sbst/downloadthetool/

Related Research

• Beneciuk, J. M., Bishop, M. D., Fritz, J. M., Robinson, M. E., Asal, N. R., Nisenzon, A. N. and George, S. Z. (2012) 'The STarT Back Screning Tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings' Physical Therapy 
• Bruyere, O., Demoulin, M., Brereton, C., Humblet, F., Flynn, D., Hill, J. C., Maquet, D., Beveren, J. V., Reginster, J., Crielaard, J. and Demoulin, C. (2012) 'Translation validation of a new back pain screening questionnaire (the STarT Back Screening Tool) in French' Archives of Public Health [online] 70, (12). Availalbe form <http://www.archpublichealth.com/content/pdf/0778-7367-70-12.pdf> [29 July 2013]
• del Pozo-Cruz, B., Parraca, J. A., del Pozo-Cruz, J., Adsuar, J. C., Hill, J. C. and Gusi, N. (2012) 'An occupational, internet-based intervnetion to prevent chronicity in subacute lower back pain: a randomized controlled trial' Journal of Rehabilitation Medcine 44, (7) 581-587 
• Field, J. and Newell, D. (2012) 'Relationship between STarT Back Screening Tool and prognosis for low back pain patients recieving spinal manipulative therapy' Chiropractic & Manual Therapies 20, (1) 17.
• Foster, N. E., Mullis, R., Young, J., Doyle, C., Lewis, M., Whitehurst, D. and Hay, E. M. (2010) 'Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective popualtion-based sequential comparison' BMC Musculoskeletal Disorder 20, (11) 186.
• Fritz, J. M., Beneciuk, J. M. and George, S. Z. (2011) 'Relationship between categorization with the STarT Back Screening Tool and prognosis for people receiving physical therapy for low back pain' Physical Therapy [online] 91, (5) 722-732. Availalbe from <http://ptjournal.apta.org/content/91/5/722
• Foster, N. E. and Delitto, A. (2011) 'Embedding psychological perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice-challenges and opportuities' Physical Therapy [online] 91, (5) 790-803. Availalbe from <http://ptjournal.apta.org/content/91/5/790> [29 July 2013]
• Hay, E., Dunn, K., Hill, J., Lewis, M., Mason, E., Konstantinou, K., Sowden, G., Somerville, S., Vohora, K., Whitehurst, D. and Main, C. (2008) 'A randomised clinical trial of subgrouping and targeted for low back pain compared with best current care. The STarT Back Trail Study Protocol' BMJ Musculoskeletal Disorders [online] 9 58-66. Availalble from <http://www.biomedcentral.com/content/pdf/1471-2474-9-58.pdf> [24 July 2013]
  
• Hill, J. C., Dunn, K. M., Lewis, M., Mullis, R., Main, C. J., Foster, N. E. and Hay, E. M. (2008) 'A primary care back pain screening tool: identifying patient subgroups for initial treatment' Arthritis Care & Research [online] 59, (5) 632-641. Availalbe from <http://onlinelibrary.wiley.com/doi/10.1002/art.23563/full> [23 July 2013]
• Hill, J. C., Dunn, K. M., Main, C. J. and Hay, E. M. (2012) 'Subgrouping low back pain: a comparison of the STarT Back Tool with the Orebro Musculoskeletal Pain Screening Questionnaire' European Journal of Pain [online] 14, (1) 83-89. Availalbe from <http://onlinelibrary.wiley.com/doi/10.1016/j.ejpain.2009.01.003/abstract> [23 July 2013]
  
• Hill, J. C., Foster, N. E. and Hay, E. M. (2010) 'Cognitive behavioural therapy shown to be an effective and low cost treatment for subacute and chronic low-back pain, improving pain and disability scores in a pragmatic RCT' Evidence Based Medicine 15, (4) 118-119.
• Hill, J. C. and Fritz, J. M. (2011) 'Pschosocial influences on low back pain, disability, and response to treatment'Physical Therapy [online] 91 712-721. Availalbe from <http://ptjournal.apta.org/content/91/5/712.abstract> [24 July 2013]
• Hill, J. C. (2010) 'The early identification of patients with complex back pain problems' The Back Care Journal [online] Spring Availalbe from <http://content.yudu.com/Library/A1ns0p/BackCareSpring2010/resources/index.htm?referrerUrl=http%3A%2%2Fwww.yudu.com%2Fitem%2Fdetails%2F164377%2FBackCare-Spring-2010> [24 July 2013]
• Hill, J. C., Vohora, K., Dunn, K. M., Main, C. J. and Hay, E. M. (2010) 'Comparing the STarT Back Screening Tool's subgroup allocation of individual patients with that of independent clinical experts' Clinical Journal of Pain [online] 26, (9) 783-787. Availalbe from <http://journals.lww.com/clinicalpain/pages/articleviewer.aspx?year=2010&issue=11000&article=00008&type=abstract> [29 July 2013]
• Hill, J. C., Whitehurst, D. G., Lewis, M., Bryan, S., Dunn, K. M., Foster, N. E., Konstantinou, K., Main, C. J., Mason, E., Somerville, S., Sowden, G., Vohora, K. and Hay, E. M. (2011) 'Comparison of stratified primary care management for low back pain with curent best ractice (STarT Back): a randomised controlled trial' Lancet [online] 378, (9802) 1560-1571. Availalbe from <http://www.ncbi.nlm.nih.gov/pubmed/21963002> [29 July 2013]
  
• Kongsted, A., Johannesen, E. and Leboeuf-Yde, C. (2011) 'Feasibility of the STarT Back Screening Tool in chiropractic clinics: a cross-sectional study of patients with low back pain' Chiropractic & Manual Therapies 19, (1) 10. 
• Main, C. and George, S. (2011) 'Psychologically informed practice for management of low back pain: future directions in practice and research' Physical Therapy [online] 91, (5) 820-824. Availalbe from <http://www.ncbi.nlm.nih.gov/pubmed/21451091> [29 Juy 2013]
• Main, C. J., Sowden, G., Hill, J. C., Watson, P. J. and Hay, E. M. (2012) 'Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's 'high risk' intervention (StarT Back; ISRCTN 37113406)' Physiotherapy [online] 98, (2) 110-116. Availalbe from <http://www.sciencedirect.com/science/article/pii/S0031940611004202> [29 July 2013]
• Morso, L., Albert, H., Kent, P., Manniche, C. and Hill, J. (2011) 'Translation and discriminative validation of the STarT Back Screening Tool into Danish' European Spine Journal [online] 20, (12) 2166-2173. Availalbe from <http://link.springer.com/article/10.1007%2Fs00586-011-1911-6> [29 July 2013]
  
• Sowden, G., Hill, J. C., Konstantinou, K., Khanna, M., Main, C. J., Salmon, P., Somerville, S., Wathall, S. and Foster, N. E. (2011) 'Subgrouping for targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281)' Family Practice [online] 0 1-13. Availalbe from <http://fampra.oxfordjournals.org/content/early/2011/06/27/fampra.cmr037.full.pdf+html> [29 July 2013]
• Whitehurst, D. G., Bryan, S., Lewis, M., Hill, J. and Hay, E. M. (2012) 'Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups' Annals of the Rheumatic Diseases 71, (11) 1796-1802.
• Widerman, T. H., Hill, J. C., Main, C. J., Lewis, M., Sullivan, M. J. and Hay, E. M. (2012) 'Comparing the responsiveness of a brief, multidimensional risk screening tool for back pain to its unidimensional reference standards: the whole is greater than the sum of its parts' Pain 152 (11) 2182-2191

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References

• Hill, J. C., Dunn, K. M., Lewis, M., Mullis, R., Main, C. J., Foster, N. E. and Hay, E. M. (2008) 'A primary care back pain screening tool: identifying patient subgroups for initial treatment' Arthritis Care & Research [onine] 59, (5) 632-641. Available from <http://onlinelibrary.wiley.com/doi/10.1002/art.23563/full> [29 July 2013]
• Hill, J. C., Whitehurst, D. G., Lewis, M., Bryan, S., Dunn, K. M., Foster, N. E., Konstantinou, K., Main, C. J., Mason, E., Somerville, S., Sowden, G., Vohora, K. and Hay, E. M. (2011) 'Comparison of stratified primary care management for low back pain with current bset practice (STarT Back): a randomised controlled trial' Lancet [online] 378, (9802) 1560-1571. Available from <http://www.ncbi.nlm.nih.gov/pubmed/21963002> [29 July 2013]
• Keele University (n. d.) STarT Back Screening Tool Website [online] available from <http://www.keele.ac.uk/sbst/> [23 July 2013]