STarT Back - stratified care for low back pain - includes a screening tool, which assesses and stratifies patients with back pain according to their individual risk of developing persistent, long-term back pain, with matched treatment pathways which target those risks, and to which patients may be fast-tracked. In the research trial, Keele University researchers showed that the use of the STarT Back approach could both improve patient outcomes and reduce costs. An implementation study also demonstrated similar clinical and cost effectiveness outcomes to the research trial, in particular:
• Physiotherapy services could be geared to providing targeted treatments according to patients’ individual levels of risk.
• The use of the STarT Back screening tool was feasible in General Practice.
• STarT Back was effective in targeting medium and high risk patients with more effective treatments while reducing referral rates for low risk patients.
The research was well received in health care contexts and gained the attention of wider society through positive media reporting. Keele University were particularly motivated to ensure that STarT Back prove as effective in practice as the research promised and, through a dedicated implementation team, have been driving the implementation in selected locations.
Our study aims to review and in part follow the STarT Back implementation journey as it is adopted by practitioners, learning about the issues the implementation team and the practice locations face as they embed world class research into everyday practice. We follow a similar approach to our study of the implementation of the maternity triage by adopting a social science perspective of how knowledge and innovation can become embedded within organisations. The data analysis will be based on interviews, observations and documentation and guided by relevant theories enabling cross-case learning between studies.