Relationship between STarT Back Screening Tool and prognosis for low back pain patients receiving spinal manipulative therapy
Open accessAbstract
BACKGROUND: Low back pain (LBP) is common and costly and few treatments have been shown to be markedly superior to any other. Effort has been focused on stratifying patients to better target treatment. Recently the STarT Back Screening Tool (SBT) has been developed for use in primary care to enable sub grouping of patients based on modifiable baseline characteristics and has been shown to be associated with differential outcomes. In the UK the SBT is being recommended to assist in care decisions for those presenting to general practitioners with LBP. In the light of growing recommendation for widespread use of this tool, generalisability to other LBP populations is important. However, studies to date have focused only on patients attending physiotherapy whereas LBP patients seeking other treatment have not been investigated. AIMS: This study aims to investigate the utility of the SBT to predict outcomes in LBP patients presenting for chiropractic management. METHODS: A total of 404 patients undergoing chiropractic care were asked to complete the SBT before initial treatment. Clinical outcomes were collected at 14, 30 and 90 days following this initial consultation. The clinical course was described comparing SBT categories and logistic regression analysis performed to examine the tool's prognostic utility. RESULTS: Although the high-risk categories had greater pain at baseline this difference rapidly faded, with both change in composite outcome scores and pain scores being statistically insignificant between the risk groups at 30 and 90 days follow up. In addition, both univariate and adjusted analysis showed no prognostic utility of the SBT categorisations to differentiate clinical outcomes between risk groups. CONCLUSION: Whilst the SBT appears useful in some back pain populations it does not appear to differentiate outcomes in LBP patients seeking chiropractic care.
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The items used for impact stratification (pain intensity, pain interference, and functional status) have substantial research support for their discriminatory and prognostic importance.
“These items have substantial research support to validate their discriminatory and prognostic importance. 13, 19, 31, 38, 39, 43, 47–49, 53, 54, 57–60, 66–68, 73, 76, 80, 82, 85, 86, 97, 106, 108, 110, 112–116, 122”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [47]
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Self-citationYoung, K. J., Young, H. C., & Field, J. R. (2024) · Figshare · doi:10.6084/m9.figshare.25107698
Self-citationTranslation, validation, and reliability of Örebro Musculoskeletal Screening Questionnaire in Nepali
Mahto, P. K., Unsgaard‐Tøndel, M., Naidoo, V., Joshi, S. K., & Stensdotter, A. (2026) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-026-09818-6
- Authors
- Field, J., & Newell, D.
- Corresponding author
- Field, Jonathan
- ORCID
- Field, Jonathan
- Venue
- Chiropractic & Manual Therapies
- Published
- 2012-06-12
- Volume
- 20
- Issue
- 1
- Pages
- 17-17
- ISSN
- 1746-1340 (ISSN-L)
- 2045-709X
- PMC
- PMC3422208
- OpenAlex
- W2136956079
- Cited by
- 61
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 12 · 2014: 10 · 2013: 7
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Chiropractic & Manual Therapies (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Keywords
- STarT Back Screening Tool, low back pain, spinal manipulation, chiropractic, prognostic utility, patient stratification, risk classification, clinical outcomes, pain scores, generalizability
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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