Implementation

Extending STarT Back for use in other Musculoskeletal conditions:

The Keele STarT Back Team receives regular enquiries about whether the STarT Back Tool, in particular the 5 generic psychosocial items, can be used for other musculoskeletal conditions.

The Keele team have therefore collected clinical data in order to test the performance of a modified version of the STarT Back Tool within patients that have a range of common musculoskeletal conditions. This data is currently being analysed and we aim to publish our findings before the end of 2013.

For now, we therefore wish to emphasise that we are unable to recommend the use of a modified version of the STarT Back Tool for conditions other than low back pain.

NHS England has issued legal guidance on the use of risk stratification tools within clinical practice which highlights the need for robust evidence prior to risk stratification tools being used in clinical practice. It also states that where risk tools are used in an automated manner (without clinician oversight) in respect to treatment decision making, patient consent is first required for their data to be used in this way. Please see the Information_Governance and Risk Stratification:Advice and Options for CCGs and GPs leaflet. 

 The STarT Back tool was always intended for, and has been used in the context of a consultation with a health care professional to aid clinical decision-making (not as a stand alone tool) and to support the targetting of appropriate interventions. The Keele team consensus is that use of the STarT Back Tool in clinical practice for non-spinal conditions does not at present have sufficient evidence.

 
The Keele team are fully aware that in Scotland the NHS 24 musculoskeletal triage system is piloting the use of the modified STarT Back Tool for all musculoskeletal patients as part of their call handler's triage algorithm and we look forward to seeing their results in due course. Keele University does not take any responsibility or liability for the actions and treatment decisions of the NHS 24 musculoskeletal triage service.

Are you thinking of implementing this approach in your service? Here is a summary of the evidence to support you.

Supporting statement

 

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