The Keele STarT Back Screening Tool
© Keele University 01/08/07 Funded by Arthritis Research UK
Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Thinking about the last 2 weeks tick your response to the following questions:
*
Rows
Disagree
Agree
1. My back pain has spread down my leg(s) at some time in the last 2 weeks
2. I have had pain in the shoulder or neck at some time in the last 2 weeks
3. I have only walked short distances because of my back pain
4. In the last 2 weeks, I have dressed more slowly than usual because of back pain
5. It’s not really safe for a person with a condition like mine to be physically active
6. Worrying thoughts have been going through my mind a lot of the time
7. I feel that my back pain is terrible and it’s never going to get any better
8. In general I have not enjoyed all the things I used to enjoy
9. Overall, how bothersome has your back pain been in the last 2 weeks?
*
Not at all
Slightly
Moderately
Very much
Extremely
Total Score
Sub Score (Q5-9)
Submit
Should be Empty: