MUSCULOSKELETAL
MATTERS
Bulletin 9
Electronic templates and the management
of patients with low back pain
Most patients who present with back pain to
primary care do not have a serious underlying
condition. The STarT Back approach uses a
brief easy-to-complete 9-item tick-box tool to
assess risk (of persistent pain and disability) and
support management 1 (see Figure 1). Evidence
shows that using this stratified care approach
to provide matched treatment for this group of
patients is clinically and cost effective.
Relevance to practice
Clinicians told us that a computer template, including the STarT
Back tool, could assist them in their management of patients
with low back pain. The template would need to:
• be quick and simple to use
• auto-calculate the risk score
• recommend treatment options
• generate auto-populated physiotherapy referral forms
when necessary
Figure 1 Risk level and treatments
Refer to psychologically informed physiotherapy
Stratifying care
means assessing
patient level
of risk and
then matching
treatment to
that risk
Refer to physiotherapy
Advice and minimal intervention
Local engagement
General Practitioners in North
Staffordshire assisted with the
design of a template that can
be embedded within the EMIS
system. The template:
• opens when back pain codes
are entered
• asks the clinician to screen for
red flag symptoms and signs to
exclude serious disease
• incorporates the STarT Back
screening tool (9 questions)
and automatically generates a
risk score for poor outcome
• incorporates ‘pop-ups’ on the
computer screen to recommend
treatment options
• auto-populates physiotherapy
referral form (if required)
Local patients helped to design bespoke
information for GPs on patient.co.uk
Key messages for clinicians
and commissioners
• Stratified care for back pain is
clinically and cost effective
• A stratified approach helps to keep
physiotherapy waiting lists low
• An embedded template incorporating
the STarT Back tool is quick and easy
to use in routine consultations
• Auto-populated physiotherapy
referral forms are generated
when needed
References
Hill, J.C., Whitehurst, D.G., Lewis, M., Bryan, S., Dunn, K.M., Foster, N.E. et al. (2011) Comparison of stratified
primary care management for low back pain with current best practice (STarT Back): a randomised
controlled trial. The Lancet 378(9802), 1560-1571.
1
Contact [email protected] for more information about the template.
This is a summary of independent research funded by the National Institute for Health Research (NIHR) and a NIHR Knowledge Mobilisation grant (KMF 2012-01-35). The views expressed
are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The work is also supported by the West Midlands Academic Health Science Network.
The STarT Back study was funded by Arthritis Research UK (Grant ref. 17741)