Keele STarT Back Score

If you have been advised by the surgery to submit a Keele STarT Back Score assessment please use this form.

Keele STarT Back Score

Keele STarT Back Score

About You

Please use this date format: DD/MM/YYYY.

Keele STarT Back Screening

Thinking about the last 2 weeks tick your response to the following questions:

My back pain has spread down my leg(s) at some time in the last 2 weeks *
I have had pain in the shoulder or neck at some time in the last 2 weeks *
I have only walked short distances because of my back pain *
In the last 2 weeks, I have dressed more slowly than usual because of back pain *
It’s not really safe for a person with a condition like mine to be physically active *
Worrying thoughts have been going through my mind a lot of the time *
I feel that my back pain is terrible and it’s never going to get any better *
In general I have not enjoyed all the things I used to enjoy *
Overall, how bothersome has your back pain been in the last 2 weeks? *
This is your total score from all 9 questions
This is your sub score from questions 5-9

Please note that the details you give will be used to update your medical records.

*