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Keele STarT back score

Keele STarT Back Score
Required fields are labelled
You must be aged 13 or over to complete this form yourself
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

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.

Confirmation