Following the publication of the STarT Back Trial in the Lancet in November 2011 which demonstrated that a stratified approach to the management of patients with low back pain produced significant improvements in patients clinical outcomes (disability, work loss, pain) as well as substantial cost-savings to the NHS, we have worked to optimise the impact that this research has on clinical practice. 


We commissioned a short film to summarise the findings and to assist implementation, and have trained trainers to cascade stratified care for back pain.

To maximize the opportunity for healthcare practitioners to understand the meaning of the STarTBack results we hosted a free conference at Keele University, ‘Implementing stratified care for back pain: implications for service providers and commissioners’ in April 2012. This conference had strong Department of Health backing (Sir Muir Gray, QiPP Right Care) and delegates included representatives from numerous UK clinical commissioning groups. Currently, more than 18 community physiotherapy services across the UK have adopted the STarTBack approach to the treatment of low back pain, in addition to the 28 services who have signed up to the STarT Back website.    


The West Midlands Academic Health Science Network is working in partnership with Keele University to support the rollout of STarT Back. Three clusters of GP practices with care pathways linked to physiotherapy centres will be identified to take part across the West Midlands region, UK. The AHSN is funding project management and clinical expertise to support the engagement and training of healthcare professionals to adopt a stratified care approach to managing back pain.  Care pathways will be negotiated with local CCGs/provider Trusts to support the roll out of this approach, with the installation of the STarT Back screening tool into GP computerised consultation systems, which “pops-up” each time someone consults with back pain.  AHSN funding will support this change management and training activity. The project plan also includes embedded audit to support evaluation of implementation of the STarT Back approach.

Clinical commissioning groups across the UK are also adopting this approach including Southend, Derby, Devon, Scotland, North Staffordshire, Stoke, Cheshire, Sheffield.


The STarTBack tool has been translated into 12 languages. We are actively working with services overseas who are adopting our stratified care approach for back pain (including Australia, Denmark, Scandinavia, Canada, USA).  InterMountain Healthcare (based in Salt Lake City) have implemented this for use in Utah and Idaho(across 22 hospitals and 185 clinics), Fair View Healthcare have integrated STarT Back into their electronic patient record (EPIC) and across their services in Minnesota, and are collaborating with Group Health Cooperative who have implemented the STarT Back approach in Seattle.  The Ontario government and the Centre for Effective Clinical Practice have adopted the STarTBack approach into their guidelines and in Denmark the government has approved the training of 1000 physiotherapists using translated versions of our training materials.

The locations of our collaborators and clinical partners can be found here.

Care pathways

STarT Back has been adopted into several high quality clinical care pathways

NICE Guidelines (NG59) and Quality Standards (QS155) for Low Back Pain and Sciatica for over 16s

Allied Health Professional Musculoskeletal tool kit 

Royal College of General Practitioner e learning module