Using & scoring the Keele STarT Back Screening Tool

The SBST is being used by a range of clinicians such as general practitioners, physical therapists, osteopaths and pain management practitioners to systematically identify patients ‘at risk' of persistent symptoms. Why not add your name to the list of clinical Centres using the tool?

For guidance on the use of the tool and copyright arrangements please see 'Legal' section.

There are now several different versions of the Keele STarT Back screening tool. These are explained below.

At present the STarT Back tool is not recommended for use in other musculoskeletal or non-musculoskeletal conditions. Read more here



9-item tool: for all clinicians including GPs

This has 9 questions about predictors for persistent disabling back pain. They include radiating leg pain, pain elsewhere, disability (2 items), fear, anxiety, pessimistic patient expectations, and low mood and how much the patient is bothered by their pain. 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 and distress (psych) subscale. These are used to stratify patients into low, medium and high risk groups which have their respective matched treatment packages.

Download Keele SBST 9 item tool

SBST score flowchart

Clinical measurement tool: monitor change

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.

Download the Keele SBST Clinical Measurement Tool