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How Effective is the STarTBack Method?

How it works

STarTBack is a stratified screening tool developed by Keele University. It is used to help identify what level of risk patients with Low Back Pain (LBP) have of developing chronic LBP.

It consists of 9 simple questions so is very easy to integrate into clinical practice. It is widely used and respected throughout the UK and is a method I have been using for over 3 years with my physiotherapy teams in the NHS.

All patients are fully assessed (subjectively and objectively), but clinical reasoning and judgement still needs to be applied in each case.

Provided you are clear that the patient is dealing with musculoskeletal LBP, then the approach is to follow the STarTBack guidelines within each risk group as follows.

Low Risk Patients

Patients identified as low risk should be given appropriate advice and reassurance plus some suitable exercises to increase mobility. They should then be discharged rather than placed on standby, as evidence shows this is much more empowering and reassuring to patients than offering mixed messages such as

“There’s nothing to worry about, but just in case we’ll keep you on hold!”

There is also increasing evidence that such patients can display worse results if more physiotherapy appointments are offered to them, as this may increase their anxiety.

My own records indicate that when we adopted the STarTBack approach we reduced the number of appointments for our low risk patients from 3.11 appointments to 1.5 appointments per person which saves thousands of pounds per year.

Medium Risk Patients

In essence the medium risk group receive what might be best described as “traditional” physiotherapy. However, this does NOT include bed rest, traction, massage or electrotherapy as there is little or no evidence to support them.

Patients are offered a few physiotherapy sessions which may include some hands-on techniques. Reassurance is offered throughout along with suitable exercises to empower the patient as quickly as possible.

High Risk Patients

Undoubtedly the most challenging group is those that are identified as being at high risk, who will display increased psychological markers. Such patients can still be successfully managed within the service, but they may require more input and ultimately support from the wider multi-disciplinary team.

What are you waiting for?

So, if you’re not using the STarTBack screening tool with your own patients, the question you need to answer is, why not?

For more information and the ‘9 Point Checklist’ click HERE

Mr Gordon Smith

Physiotherapy Team Leader, NHS Trust

Senior Lecturer, University of Worcester

SOMM Tutor: Foundation Course and Injection Therapy

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