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Case Studies


The Innovation Case Studies section provides a comprehensive list of exemplar innovation projects from across the NHS. These innovations have been carefully selected to represent a range of ideas from medical technologies through to service and pathway re design. Each case study provides a background to the innovation and a contact for further information.

 Click on the Case Study Browse area on the right to find examples by clinical area.

If you have an innovation case study you would like us to publish on the portal please contact the Innovation team at england.innovation@nhs.net

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STarT Back - stratifed care for low back pain

Case study arrowBack pain is the commonest reason for middle-aged people to visit their GP, representing an estimated annual cost to the NHS of £10 billion.

It is the second most common reason for sickness absence, perisstent disability and work loss in the under 65s. Current approaches mean that a substantial proportion of patients are over-treated, while a significant number fail to get the right care.

West Midlands AHSN have adopted a stratifed care approach for low back pain (LBP) that improves clinical outcomes, patient satisfaction and care pathways; reducing disability, sickness absence and physiotherapy waiting times. The Keele STarT Back approach utilises an innovative risk startificaton tto to identify pateints' at risk of persistent LBP disability. Low risk patients are supported to self-manage in primary care, medium risk patients receive evidence based physiotherapy, and at high risk patients are treated by up-skilled physiotherapists to provide a psychologically informed approach.

Impact so far

  • An Arthritis Research UK funded trial demonstrated that StarT Bak is clinically and cost-effective, saving £34 per patient in health costs, e.g. GP visits, MRIs, mediction and £675 per patient in societal costs e.g. reduction in absence from work.
  • West Midlands AHSN is supporting scaling within and outside the region: 15 physiotherapy service within the West Midlands and a further 16 across the UK have adopted the approach.
  • High wuality patient information has been embedded into patient info for GPs to easily access during the consultation.
  • The STarT Back approach has been adopted internationally with the tool formally translated into 12 languages (8 validated).
  • Physiotherpay teams report: reduced wait times &; high patient satisfaction

Next steps

  • Work is progressing to embed the tool into additional GP clinical systems and further clusters of Trusts, GP practices and CCGs are integrating this approach into their pathways
  • A new NIHR trail led by Keele is developing and testing a general practice risk stratification approach for other common musculoskeletal pains

Funding source Logo


Contact Name Sarah Millard Email address sarah.milard@wmahsn.org

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