The Keele STarT Back Screening Tool
Legal Last Name
*
Legal First Name
*
MI
Preferred Name
Optional
Date:
/
Month
/
Day
Year
Thinking
about the last two (2) weeks, tick your response to the following questions:
1. My back pain has spread down my leg(s) at some time in the last two weeks
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Disagree (0)
Agree (1)
2. I have had pain in the shoulder or neck at some time in the last two weeks
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Disagree (0)
Agree (1)
3. I have only walked short distances because of my back pain
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Disagree (0)
Agree (1)
4. In the last two weeks, I have dressed more slowly than usual because of my back pain
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Disagree (0)
Agree (1)
5. It's not really safe for a person with a condition like mine to be physically active
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Disagree (0)
Agree (1)
6. Worrying thoughts have been going through my mind a lot of the time
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Disagree (0)
Agree (1)
7. I feel that my back pain is terrible and it's never going to get any better
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Disagree (0)
Agree (1)
8. In general I have not enjoyed all the things I used to enjoy
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Disagree (0)
Agree (1)
9. Overall, how bothersome has your back pain been in the last two (2) weeks?
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Not at all (0)
Slightly (0)
Moderately (0)
Very much (1)
Extremely (1)
Total score (questions 1-9):
Sub Score (questions 5-9 only):
Submit
Should be Empty: