The STarT Back Tool: Physiotherapist Experience and Perceptions of its Clinical Utility

Abstract

i)             Rationale:

The STarT Back Tool (SBT) has been recently validated for use as a prognostic screening tool with Lower Back Pain (LBP) patients in the primary care setting (1). A recent study by Hill et al (2) concluded that LBP outcomes and cost effectiveness could be improved from using the SBT to guide decision making and providing a stratified approach to care.  The SBT was introduced to musculoskeletal physiotherapists working in the community setting for Bolton NHS Foundation Trust.

This study aims to explore the perceptions and experiences of physiotherapists using the SBT in clinical practice. No study has yet explored this

ii)            Method:

A qualitative study was conducted. A Nominal Group Technique (NGT) was undertaken to develop an appropriate set of questions for use in a single Focus Group (FG). The FG comprised of eight musculoskeletal physiotherapists. The FG was audio taped and the data obtained was analysed through Grounded Theory Methodology.

iii)          Results:

Physiotherapists felt the SBT acted in a confirmatory manner. Although deemed easy to use, a number of barriers led to only a small impact on decision making. These being, perceived oversimplification of the decision making process, impact on professional reputations and professional development, risks associated with single treatment sessions, patient satisfaction and threats to patient centred care.

iv) Conclusion:

A number of barriers reduced Physiotherapist confidence in using the SBT to guide decision making and led to physiotherapists questioning whether a stratified approach to LBP management represented the ‘best care’ for their patients. The study highlighted the importance of a robust training prior to and during the implementation of the SBT and a stratified approach to care within physiotherapy departments.