Low Back Pain

STarT Back Screening Tool

International Knee Documentation Committee (IKDC)

STarT Back Screening Tool

The STarT Back Screening Tool is a screening instrument for use in patients with nonspecific low back pain in primary care. Based on 9 questions an assessment is made of the psychosocial aspect of the back pain and an impression is obtained about the risk of developing persistent disabling low back pain. Finally, the results guide the treatment strategy to be followed by dividing the patients into subgroups.


Validity and Reliability

The prognostic subgroups and overall tool scores had kappa coefficients of 0.71 and 0.65, respectively, for test-retest reliability. Relative risk ratios for persistent disability were 2.19 (95% CI: 1.10-4.38) for the medium-risk group and 7.30 (95% CI: 4.11-12.98) for the high-risk group, respectively, indicating predictive validity (van den Broek et al. 2021)


Scoring and Interpretation

The STarT Back Screening Tool includes five questions: 1. fear, 2. anxiety, 3. catastrophizing, 4. feelings of depression, and 5. bothersomeness. It also includes four questions about physical risk factors for a worse prognosis: 1. referred leg pain, 2. neck/shoulder pain, 3. disability in walking, and 4. difficulties getting dressed. The overall score is 0–9 (from best to worst), and it divides the population into groups with low, medium, and high risk of having a worse prognosis.

If the overall tool score is ≤3, the prognosis risk is considered low. Individuals with a combined overall score of ≥4 and  psychosocial subscale score of ≤3 were included in the medium risk group. Those with a psychosocial subscale score over ≥4 are considered to be in the high-risk category.

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Hill JC, Dunn KM, Lewis M, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632-641. 

van den Broek AG, Kloek CJJ, Pisters MF, Veenhof C. Validity and reliability of the Dutch STarT MSK tool in patients with musculoskeletal pain in primary care physiotherapy [published correction appears in PLoS One. 2021 Jun 3;16(6):e0252912]. PLoS One. 2021;16(3):e0248616. Published 2021 Mar 

Copyright Notice

When available, sources are cited, and the tool’s developer retains ownership of the intellectual property. We consider that the modification and creation of these tools into dynamic, interactive, online scoring calculators is fair usage. Please email us if you believe we have violated your copyright so we can take down the offending material.

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