At the beginning of this interview, Jonathan discusses the STarT Back Tool. This tool identifies key clinical factors which help to predict outcomes for individuals for back pain which present to primary care. Factors which can be identified by treatment are pin pointed. The STarT back tool serves as a screening tool to help determine prognosis and appropriate treatment paths. Low risk patients have a good prognosis. Medium risk patients mostly have a poor prognosis. High risk patients have larger fear and stress influences and a poor prognosis. Nine factors determine whether somone is low, medium or high risk.
Jonathan discusses Stratified Care and the subgrouping low back pain patients. He talks about the possibilities of integrating the STarT Back Tool with other subgroupings that exist.
When assessing individuals with low back pain Jonathan states we need to keep a broad mindset. We should thoroughly question the patient. Emphasis should be placed on treating the whole patient. We should discuss the expectations and prognosis. With treating difficult patients, he feels we tend to struggle more on the psychosocial treatment of the individual. He cautions us into grouping patients strictly by their diagnosis.
Some of Jonathan’s Research
- Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 2008;59(5):632–41.
- Hill JC, Dunn KM, Main C, Hay E. Subgrouping low back pain: A comparison of the STarT Back Tool with the Örebro Musculoskeletal Pain Screening Questionnaire. Eur J. Pain 2009.
- E Hay, K Dunn, J Hill, M Lewis, E Mason, K Konstantinou, G Sowden, S Somerville, K Vohora, D Whitehurst and C Main. A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Trial Study Protocol . BMC Musculoskeletal Disorders April 2008; 9:58.