LEVEL 3 MECC – Musculoskeletal clinicians only

It is well known that back pain can be a considerable problem for some people, with great costs to them individually and to society as a whole. Effective treatments for back pain exist but often management based on clinical intuition alone fails to match the right patient to the right treatment. Stratified care aims to improve this situation, with a more systematic approach to management.

STarT Back is an example of a stratified care approach to the management of low back pain. In addition to the risks we have already covered, research shows that there are additional key risk factors that predict who is likely to go on to have persistent disabling back pain. In order to more effectively manage people with back pain a stratified care approach is recommended. This consists of:

  • Allocating patients to one of three subgroups based on their risk of persistent disability using the STaRT Back Screening tool (Keele University) The tool consists of 9 self-report items capturing 8 prognostic factors: function (2 items), radiating leg pain, pain elsewhere, depression, anxiety, fear avoidance, catastrophizing, and bothersomeness. The resuting score allocates patients into three risk groups: low, medium, or high risk of persistent disability.

  • Delivering the appropriate matched treatment pathway, according to the subgroup allocation.

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