The Keele STarT Back Screening Tool is a brief validated tool (Hill et al 2008), designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making.

The STarT Back trial, published in The Lancet, was designed to compare the clinical and cost effectiveness of stratified management approach; allocating patients to different treatment pathways based on their prognosis (low, medium, or high risk of poor outcome); with that of current best practice. The trial was funded by Arthritis Research UK (now Versus Arthritis) and demonstrates that this new model results in greater health benefits, achieved at a lower average health-care cost, with an average saving to health services of £34.39 per patient and societal savings of £675 per patient.

The tool helps primary care clinicians (GPs, physiotherapists etc) to group patients into 3 categories of risk of poor outcome (persistent disabling symptoms) – low, medium, and high-risk. By being able to categorise patients into these 3 groups, clinicians are then able to target interventions to each sub-group of patients to help improve outcome.

The IMPaCT study was a before and after implementation study that took the STarT Back approach into normal primary care in the UK. This confirmed that stratified care for low back pain leads to significant reduction in disability and halves time off work without increasing health care costs.

The instrument is being used by a range of clinicians such as general practitioners, physiotherapists, osteopaths and pain management practitioners to systematically identify patients ‘at risk’ of persistent symptoms.

STarT Back Research
We would be delighted to hear about any research plans using the STarT Back Approach with matched treatment interventions, or new stratified care approaches in other fields, as it maybe appropriate to collaborate with you. Our team has a range of researchers with different expertise – see the Table below – that you are welcome to contact.

The tool is free for researchers to use without permission – so no license is required. However, please do contact us if you want to collaborate or if you are interested in translating or validating the tool in a new language by sending an email to

For a list of STarT Back related Research Articles click here

The Keele STarT MSK Tool

Building on the success of STarTBack The Keele STarT MSK Tool was developed within the Keele Aches and Pains Study (KAPS). The tool aims to ensure that patients with common musculoskeletal conditions receive the right treatments at the earliest opportunity. The tool contains 10 items that once scored can place patients into three categories based on their risk of a poor outcome (low, medium, and high) in the most common musculoskeletal conditions (e.g. back pain, neck pain, shoulder pain, knee pain and multisite pain . The Keele STarT MSK Tool has its own dedicated website and we invite you to visit and learn more about this exciting project

STarTBack Implementation- Impact Accelerator Unit (IAU)
The Impact Accelerator Unit (IAU) aims to maximise the benefits of world-leading health and care research, making an impact on the quality of life and care for patients and the public. The team work with stakeholders to create innovations, which arise from research, offering solutions to partners’ problems, making it easier to do the right thing.

The IAU has a leading role in closing the evidence-to-practice gap by accelerating the uptake and impact of best evidence through:
• implementation of the best health research
• co-creating transformation to increase quality of care
• development of impact case studies from the best health research
• leading multi-disciplinary evidence based practice groups
• the design and delivery of knowledge mobilisation within research
• maintaining the patient voice as an integral part of knowledge brokering
• securing and delivering a strong portfolio of externally funded activity
• developing the next generation of knowledge mobilisation leaders
We have two key approaches to identifying and aligning our priorities: stakeholder-led response mode and strategic, co-created processes.
• With our partners and extended networks we have a commitment to understand stakeholder needs and address areas of uncertainty, by finding the best evidence and supporting its implementation into practice.
• We track key academic outputs from our research themes within the Faculty of Health and we operate strategies for identifying, gathering, synthesising and linking evidence from our research with our stakeholders.
We provide influence and support throughout the entire research cycle. From the very beginning we encourage researchers to think of not just the value and feasibility of their research in the NHS but the feasibility of implementing this research into practice, to support timely translation of evidence into healthcare treatment.

“At the heart of the IAU is its people, we share the same culture and values, we value partnerships, communication, respect, and we want to make a difference”
Krysia Dziedzic, IAU Director

To learn more about the activities of Keele University Impact Accelerator Uni please visit our dedicate website, email or follow us on Twitter @KeeleIAU

Keele STarT Back Research and Implementation Teams

🔹Dr Jonathan Hill– Clinical trials, tool development/validation, stratified care approaches
🔹Prof Nadine Foster – Clinical Trials, Implementation research, stratified care approaches
🔹Dr Martyn Lewis – Biostatistics and Health Economics
🔹Prof Chris Main – Psychology, training, psychologically informed interventions
🔹Dr Kate Dunn – Epidemiology, and Lead for the STarT Musc Tool
🔹🔸Dr Simon Somerville – GP researcher, educational DVDs, STartBack Clinical Champion
🔹Gemma Mansell – Mediators of treatment outcome (PhD student of J Hill)
🔹🔸Gail Sowden – STarT Back High Risk Training Lead, stratified care approaches and implementation
🔸Prof Krysia Dziedzic- Impact Accelerator Unit Director / Arthritis Research Professor of Musculoskeletal Therapies, NIHR Knowledge Mobilizations Fellow
🔸Helen Duffy – Impact Accelerator Unit Deputy Director / Head of NHS Partnerships and Engagement
🔸Kay Stevenson - Implementation of stratified care lead / Consultant Physiotherapist
🔸Nicki Evans – Impact Accelerator Unit Project Manager / Startback project manager
🔸Dr Adrian Chudyk - GP Researcher, STarTBack Clinical Champion
🔸Laura Campbell – Impact Accelerator Unit Knowledge Broker
🔸Simon Wathall - Health Informatics
🔸 Katie Jackson - Chronic Pain Physiotherapist, IMPACT Service, Midlands Partnership Foundation NHS Trust
🔸 Stephen Henderson - Chronic Pain Physiotherapist, IMPACT Service, Midlands Partnership Foundation NHS Trust
🔸 Paul Shawcross - Physiotherapist specialising in workplace health & Lecturer in physiotherapy at the University of Salford