Use of the STarT Back Screening Tool for Low Back Pain in Primary Care

Date of ISAC Approval: 
31/07/2019
Lay Summary: 
Low back pain is the most common reason for absence from work and for years lived with disability in the UK. Effective treatments exist but there is variability in how they are provided in primary care. The STarT Back screening tool consists of nine questions and allows the GP to match treatment for back pain to the patient based on their risk of poorer outcomes (for example, more disability). The STarT Back tool has been shown to have significant benefits for patients in terms of reducing disability, for employers (reduced costs from time off work), and for the NHS (lower treatment costs). The tool is endorsed by the National Institute for Health and Care Excellence, Public Health England, and the NHS. Keele University's "Impact Accelerator Unit" aimed to increase the use of the STarT Back tool in primary care across the UK. However, it is unclear how often the STarT Back tool is used by GPs, nor how much its use varies by patient characteristics such as age, and by geographical region. This study aims to determine how frequently the tool is used in primary care, how this has changed over time, and whether use varies by patient demographics and geographical region. We will use the AURUM database to determine the number of practices who use the tool and within these the percentage of patients with a coded record of low back pain who also have a coded record of use of the STart Back tool.
Technical Summary: 
Back pain may lead to persistent disabling symptoms, low quality of life, and reduced capacity to work. Effective treatments exist but there is variability in how they are provided in primary care. The Keele STarT Back Screening Tool is a brief (9 item) tool designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making. Patients are allocated to treatment pathways based on their prognosis (low, medium, or high risk of poor outcome) as determined by the STarT Back tool. It has been shown to be clinically and cost effective and is endorsed by the National Institute for Health and Care Excellence, Public Health England and the NHS. Keele University's "Impact Accelerator Unit" has implemented STarT Back with the aim to scale its use up nationally. In collaboration with EMIS, we have developed a template for use in general practice which allows completion of the STarT Back tool. Codes are entered into the medical record when the template is fired and to record responses to the items included in the STarT Back tool. The template is expanding in use within UK practices using EMIS software. However it is unclear how often the STarT Back tool is used, nor how this varies by patient characteristics and geographical region. This study aims to determine how frequently the tool is used in primary care, how this has changed over time, and whether its use varies by patient demographics and geographical region. We will use the AURUM database to determine practices who use the tool and within these the percentage of patients with a coded record of low back pain who also have a record of use of the STart Back tool. We will assess associations with patient's age, gender, multimorbidity and calendar time.
Health Outcomes to be Measured: 
Recorded use of the STart Back tool in primary care
Collaborators: 

Professor Krysia Dziedzic - Chief Investigator - Keele University
Dr Adrian Chudyk - Collaborator - Keele University
Professor Harry Scarbrough - Collaborator - City University London
Mr James Bailey - Collaborator - Keele University
Ms Kay Stevenson - Collaborator - Keele University
Dr Kelvin Jordan - Corresponding Applicant - Keele University
Mr Simon Wathall - Collaborator - Keele University
Dr Yaru Chen - Collaborator - City University London