Improving the effectiveness of primary care for low back pain: the Sub-grouping for Targeted Treatment (STarT Back) trial

Conditions

Low back pain Musculoskeletal Diseases Back pain

Richard L. Skolasky, Elizabeth Colantuoni, Stephen T. Wegener, Kisha J. Ali, Kevin H. McLaughlin

BMJ Open2025-06-01

10.1136/bmjopen-2025-102773

Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.

Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM.

2011-09-28883 citations

10.1016/s0140-6736(11)60937-9

Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281).

Sowden G, Hill JC, Konstantinou K, Khanna M, Main CJ, Salmon P, Somerville S, Wathall S, Foster NE, IMPaCT Back study team.

2011-06-2744 citations

10.1093/fampra/cmr037

A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol.

Hay EM, Dunn KM, Hill JC, Lewis M, Mason EE, Konstantinou K, Sowden G, Somerville S, Vohora K, Whitehurst D, Main CJ.

2008-04-2296 citations

10.1186/1471-2474-9-58

Interventions

1. Targeted treatment arm: The new intervention to be tested in this trial is ?targeted treatment?, which will be allocated according to the sub-grouping tool, and administered on a stepped-care basis

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Males and females age 18 and over with non-specific low back pain 2. Able to give informed and written consent

Exclusion criteria

Exclusion criteria: 1. Persons with ?red flags? indicative of possible serious spinal pathology 2. Serious co-morbidity 3. Psychiatric illness/personality disorder 4. Recent spinal surgery (less than six months) 5. Pregnancy 6. Already receiving treatment for this episode of back pain

Design outcomes

Primary

Measure	Time frame
1. Roland Morris Disability Questionnaire 2. Pain Catastrophising Scale	—

Secondary

Measure	Time frame
1. Recurrence of back pain 2. Fear avoidance (Tampa Scale of Kinesiophobia) 3. Back pain bothersomeness 4. Anxiety and depression (Hospital Anxiety and Depression Scale) 5. Self-reported global change in back problem 6. Pain intensity 7. Patient perceptions of their low back pain 8. Patient satisfaction 9. Overall health status (EuroQol instrument [EQ5D], Short Form health survey version two [SF12 vs2])	—

Measure

Time frame

1. Recurrence of back pain 2. Fear avoidance (Tampa Scale of Kinesiophobia) 3. Back pain bothersomeness 4. Anxiety and depression (Hospital Anxiety and Depression Scale) 5. Self-reported global change in back problem 6. Pain intensity 7. Patient perceptions of their low back pain 8. Patient satisfaction 9. Overall health status (EuroQol instrument [EQ5D], Short Form health survey version two [SF12 vs2])

—

Countries

United Kingdom

Outcome results

None listed