Copyright (©2021) University of Keele. No license is required for non-commercial use.  If you would like to incorporate the tool in any way into commercial product materials, please contact Keele University Impact Accelerator Unit for further advice.


The STarT Back Approach research was part-funded by Arthritis Research UK (now Versus Arthritis).


The tool is designed for use by health care practitioners, with appropriate treatment packages for each of the stratified groups; ii) the tool is not intended to recommend the use of any particular product or service provider.

Extending STarT Back for use in other musculoskeletal conditions

The Keele STarT Back Team regularly receives enquiries about whether the STarT Back Tool, in particular the 5 generic psychosocial items, can be used for other musculoskeletal conditions.

The Keele team has therefore collected clinical data in order to test the performance of a modified version of the STarT Back Tool within patients that have a range of common musculoskeletal conditions. This data is currently being analysed and we aim to publish our findings in due course. Once published it will be announced in the News section of our website.

For now, we, therefore, wish to emphasise that we are unable to recommend the use of a modified version of the STarT Back Tool for conditions other than low back pain.

The Keele team is fully aware that in Scotland the NHS 24 musculoskeletal triage system is piloting the use of the modified STarT Back Tool for all musculoskeletal patients as part of their call handler’s triage algorithm and we look forward to seeing their results in due course. Keele University does not take any responsibility or liability for the actions and treatment decisions of the NHS 24 musculoskeletal triage service.

Non-musculoskeletal conditions

The Keele team consensus is that use of the STarT Back Tool in clinical practice for non-spinal conditions does not at present have sufficient evidence.

Risk stratification

NHS England has issued IG and risk stratification: advice for CCGs and GPs‌ on the use of risk stratification tools within clinical practice that highlights the need for robust evidence prior to risk stratification tools being used in clinical practice. It also states that where risk tools are used in an automated manner (without clinician oversight) in respect to treatment decision-making, patient consent is first required for their data to be used in this way.

The STarT Back Tool was always intended for, and has been used in the context of a consultation with a health care professional to aid clinical decision-making (not as a stand-alone tool) and to support the targeting of appropriate intervention.


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