Keele University
STarT Back Screening Tool Website
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Using and Scoring The Keele STarT Back Screening Tool
The Keele SBST 9-item version
The Keele SBST 9-item tool is available in a number of languages, including English, Dutch, French, Spanish, Danish and Welsh. The questions it includes were selected because they are established predictors for persistent disabling back pain. They include radiating leg pain, pain elsewhere, disability (2 items about difficulties with dressing & walking taken from the Roland and Morris Disability Questionnaire), fear (1 item from the Tampa Scale of Kinesiophobia), anxiety (1 item from the Hospital Anxiety and Depression Scale), pessimistic patient expectations (1 item from the Pain Catastrophising Scale), and low mood,(1 item from the Hospital Anxiety and Depression Scale) and how much the patient is bothered by their pain (from Dunn & Croft 2005). All 9-items use a response format of ‘agree' or ‘disagree', with exception to the bothersomeness item, which uses a Likert scale.
The Keele SBST 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 & 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
- The overall score is used to separate the low risk patients from the medium-risk subgroup. Scores range 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.
The Keele SBST 6-item version
The 6-item tool includes 6 of the same items as the 9-item tool, with 3 items excluded (fear, anxiety and pain elsewhere), making it quicker to use. However, our (unpublished) research indicates that it is only able to allocate patients to one of two subgroups (low-risk or high-risk). Patients who score 3 or more items positively have a high-risk of persistent disabling low back pain.
Instructions on embedding the 6-item Keele STarT Back Tool onto an EMIS system are provided here - 6-item EMIS tool
Using and scoring the Keele SBST clinical measurement tool
The 9-item clinical measurement tool is designed to help clinicians objectively measure the severity of the domains screened by the 9-item tool. When repeated measures are used this enables an objective marker of change over time to be made for individual items.
Cut-offs have been established for each item - to enable those using this tool to subgroup patients in the same way as the 9-item screening tool. The cut-off points that equate to an agree/positive score on the clinical measurement tool for subgrouping are:
Leg pain - 'moderately' or more
Shoulder/neck - slightly or more
Dressing - 5 or more
Walking - 5 or more
Fear - 7 or more
Worry - 3 or more
Catastrophising - 6 or more
Mood - 7 or more
Bothersomeness - 'very' or more
Its very easy to produce an acetate using these cut-offs that you place over the questionnaire to quickly enable you to score the clinical measurement tool for subgrouping purposes.
Using and scoring the generic condition tool
The 5-item generic condition tool is the 9-item psychosocial subscale modified to screen/identify distress in other conditions. S cores range from 0 to 5 with patients scoring 4 or 5 being classified as high psychosocial risk.
When using the tool please ensure the copyright and funding statement is maintained at all times.
