Keele Start Back Tool (SBT) for assessment of low back pain with and without sciatica

Last edited 10/2020 and last reviewed 11/2020

Low back pain (LBP) is the most common reported musculoskeletal disorder, with large prevalence numbers and high costs. Focus on early identification of patients at risk of developing chronic LBP has increased. The Keele Start Back Tool (SBT) is a questionnaire aiming at screening prognostic indicators in LBP patients, categorizing patients into risk-groups and guide treatment

• NICE suggest to consider using risk stratification (for example, the STarT Back risk assessment tool) at first point of contact with a healthcare professional for each new episode of low back pain with or without sciatica to inform shared decision-making about stratified management (1)
  
  
• SBT score stratifies individuals to low, medium or high risk of a worse prognosis (2)
  
  
• using the SBT for triaging to different risks and treatments in primary care settings, in comparison with a control group not using the SBT, the stratified approach has been shown to improve outcome measures such as pain intensity, catastrophizing, fear, anxiety, depression, general health and absenteeism (3)
  
  
• however it has been noted that the SBT does not capture all of those at high risk (4) - also SBT does not consider pain distribution or if the pain is multisite or not
  
  
• study evidence has shown SBT was reliable and the screening ability was good as the subgrouping of patients into risk-groups reflected the severity of their back problems. The SBT may be an applicable and useful tool in physiotherapy practice (5)

Reference:

• NICE (October 2020). Low back pain and sciatica in over 16s: assessment and management
• Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–641. doi: 10.1002/art.23563
• Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low Back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378(9802):1560–1571. doi: 10.1016/S0140-6736(11)60937-9
• Hill JC, Dunn KM, Main CJ, Hay EM. Subgrouping low Back pain: a comparison of the STarT back tool with the Orebro musculoskeletal pain screening questionnaire. Eur J Pain. 2010;14(1):83–89. doi: 10.1016/j.ejpain.2009.01.003.
• Robinson HS, Dagfinrud H.Reliability and screening ability of the StarT Back screening tool in patients with low back pain in physiotherapy practice, a cohort study.BMC Musculoskelet Disord. 2017; 18: 232.