Condition-specific outcome measures for low back pain

A literature review of the nine most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects and available languages were analysed for the nine most-used outcome tools. When considering which condition-specific measure to employ, the present overview on assessment tools should provide the necessary information to define the technical aspects of the nine questionnaires. These criteria, however, are only part of the consideration. In part II the construction of these scales in relationship to the measurement domains will be evaluated.     

Cross-cultural adaptation and validation of the NASS outcomes instrument in Spanish patients with low back pain

Objectives: The aim of the study was to evaluate validity, reliability, responsiveness and practicality of the NASS-AAOS (North American Spine Society—American Academy of Orthopaedic Surgeons) questionnaire in patients with low back pain. Methods: The sample included 70 patients with herniated disk, stenosis, chronic low back pain of unknown etiology or acute low back pain. They were assessed twice before treatment (test–retest) and a third measure six months to one year afterwards. Results: The mean time of administration was 24 and 20 min for the test and post-treatment evaluation, respectively. Cronbachs alpha coefficient was between 0.78 and 0.92 on the baseline test and 0.90 or higher on the post-treatment evaluation. The test–retest reproducibility was 0.95 (0.91–0.98) for neurological symptoms, 0.82 (0.63–0.91) for pain/disability and 0.63 (0.25–0.82) for expectations. The associations with other measures and clinical criteria were generally moderate to high and in the expected direction. The effect size for pain/disability in combination with neurological symptoms was 2.02 for patients who improved versus an effect of –0.09 in patients who were stable between test and retest; the area under the curve on this joint scale was 0.81 (0.69–0.90). Conclusions: The instrument is valid, sensitive to clinical changes and reliable for comparisons between groups, but further study is needed for its application in monitoring individual patients.     

Cross-cultural adaptation and validation of the Norwegian version of the Core Outcome Measures Index for low back pain

Purpose

The Core Outcome Measures Index (COMI) is a short multidimensional scale covering all domains recommended to be included as outcome measures for patients with low back pain (LBP). The purpose of the present study was to translate and cross-culturally adapt the COMI into Norwegian and to test clinimetric properties of the Norwegian COMI version in patients with non-specific LBP recruited from various clinical settings.

Methods

Ninety patients with non-specific LBP from primary care and hospital settings participated in the validation part and 61 also in the reproducibility part of the study (1 week apart). Acceptability, data quality, reproducibility and construct validity were investigated.

Results

The questionnaire was well accepted and with little missing data and end effects. Reliability in terms of intraclass correlations (ICC) was satisfactory for the COMI index [0.89 (95 % CI 0.82–0.94)] and most single-core items. Agreement was acceptable for the COMI index [standard error of measurement (SEM_agreement) 0.80, minimal detectable change (MDC_individual) 2.21], but exceeded the minimal standard of acceptability in some of the individual core items. Construct validity was acceptable for the COMI index.

Conclusion

The Norwegian version of the COMI index shows acceptable clinimetric properties in our patient population, but some of the sub-items had shortcomings. Our study, however, support the usefulness of the COMI index as an applicable stand-alone global scale when a light respondent burden is advisable.     

Condition-specific outcome measures for low back pain

A literature review of the most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. In part I, technical issues such as validity, reliability, availability and comparability were analyzed for the nine most widely used outcome tools. This second part focuses on the content and wording of questions and answers in each of the nine questionnaires, and an analysis of the different score results is performed. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaires.     

Reliability and validity of the cross-culturally adapted French version of the Core Outcome Measures Index (COMI) in patients with low back pain

Purpose  

To conduct a cross-cultural adaptation of the Core Outcome Measures Index (COMI) into French according to established guidelines.     

Neck and back pain specific outcome assessment questionnaires in the Spanish language: a systematic literature review

Background contextAccurate measurement of functional improvement in clinical practice is becoming increasingly recognized as essential in demonstrating whether patients are deriving meaningful benefit from care. Several simple questionnaires have been developed for this purpose. The majority of these have been developed in English. In North America, there is a growing need for clinical tools, including outcome assessment tools that are available in the Spanish language.PurposeThe purpose of this study was to systematically review the literature regarding spine-specific outcome assessment questionnaires that are available in Spanish and to examine the evidence on their clinical utility.Study designSystematic review.MethodsThe Medline, CINAHL, Embase, and MANTIS databases were searched for any studies on the topic of outcome assessment questionnaires in the Spanish language. Relevant articles were reviewed, and the data on reliability, validity, time to completion, and any other properties of the questionnaire was extracted.ResultsThe search strategy identified 287 articles, of which 10 were deemed relevant. With regard to neck pain, data were found regarding Spanish translations of the Northwick Park Neck Pain Questionnaire, Neck Disability Index (NDI), and Core Outcome Measure for neck pain. With regard to low back pain, data were found regarding Spanish translations of the Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), and the North American Spine Society—American Academy of Orthopedic Surgeons questionnaire.ConclusionsSeveral reliable and valid outcome assessment questionnaires are available in the Spanish language. All were originally developed in English. It appears from the data reviewed that the most useful instruments are the NDI for neck pain patients and the ODI and RMQ for low back pain patients. The current trend is for the development of culturally adapted versions of these questionnaires that are specific to a particular country or region.     

Validation of the Japanese version of the Roland-Morris Disability Questionnaire

The study was designed to validate a translated, culturally adapted questionnaire. We examined the reliability, validity, and responsiveness of the Japanese version of the Roland-Morris Questionnaire (RDQ) when assessing disability in Japanese patients with low back pain. The RDQ is a reliable, validated scale used to measure disability caused by low back pain. However, no validated Japanese version of this questionnaire is available. A series of 214 outpatients with low back pain participated in this validation study. The patients were given the RDQ and the SF-36, and assessed their pain and global rating of health. Among them, 57 who were clinically stable were given the RDQ again 2 weeks later. The reliability was examined based on the test-retest method and internal consistency. Sufficient reliability was demonstrated with a Chronbach's · coefficient of 0.85, and the reproducibility for the 30 patients was r = 0.91. The principal component analysis showed unidimensionality. The RDQ score of the 133 patients was significantly improved after treatment. The Japanese version of the RDQ is a useful scale that is easy to use with reliability, validity, and responsiveness when assessing patients with low back pain.     

Responsiveness of the Brazilian–Portuguese version of the Oswestry Disability Index in subjects with low back pain

When quality of life questionnaires are used as measures of treatment outcomes, it is essential to know how well these can respond to clinical changes. The objective of this study is to examine the responsiveness of the Brazilian–Portuguese version of the Oswestry Disability Index (ODI-Brazil) in subjects with chronic low back pain submitted to a physical therapy program. Thirty subjects with chronic low back pain completed the ODI-Brazil questionnaire, along with an 11-point pain visual analogue scale (Pain VAS), and the Brazilian–Portuguese version of Roland–Morris disability questionnaire before and after the program. All patients also completed a global perception of change Likert scale in condition after the program. This scale was collapsed to produce a dichotomous variable outcome: improved and non-improved. Responsiveness was determined using effect size statistics and receiver operating characteristic curve (ROC curve), with best cut-point analysis. The best change score cut-off was identified when equally balanced sensitivity and specificity was found, as an expression of the minimum clinically important difference (MCID). After treatment, 19 patients considered themselves improved. Both the effect size (0.37) and the area under the ROC curve (0.73) for ODI-Brazil score in relation to global outcome after program indicated that the ODI-Brazil showed responsiveness. The ROC curve for ODI-Brazil was distributed at the upper corners of the diagonal line, indicating that the questionnaire presents discriminative ability. The best cut-off point for ODI-Brazil was approximately 4.45 points (63.2% sensitivity, 81.8% specificity). The Brazilian–Portuguese version of ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in chronic low back pain patients receiving conservative care.     

Oswestry功能障碍指数评定腰痛患者的可信性

目的 :探讨Oswestry功能障碍指数 (OswestrydisabilityIndex ,ODI)应用于腰痛患者评定的可信性。 方法 :住院拟手术的腰痛患者 2 2例 (男 13,女 9例 ) ,分为同一检查者重复评定 (A组 ) :10例 ,平均年龄 4 7 7岁 ;不同检查者重复评定 (B组 ) ,12例 ,平均年龄 36 6岁。用ODI对所有对象重复评定 ,平均间隔 3 0d。对两组患者的障碍指数进行Pearson相关分析。结果 :两组重复测试ODI的相关系数分别为 0 95 3和 0 912 ,相关性非常显著 (A组 :t =8 85 1,P <0 0 0 1;B组 :t=7 0 0 8,P <0 .0 1)。结论 :用ODI评定腰痛是稳定、可靠的 ,可作为腰痛患者是否需要手术或康复疗效评定的参考指标。     

The effect of walking faster on people with acute low back pain

Little is known about self-selected speed and fast walking in people with acute low back pain. This study aimed to investigate (1) the strategies that people with acute low back pain use to change from self-selected speed to fast walking and (2) the effect of a period of treadmill walking on level of back pain. Eight participants with acute low back pain and eight matched control participants were evaluated during self-selected speed and fast walking on a treadmill. The eight participants with back pain were retested 6 weeks later when pain had resolved. Measurements were taken of (1) three-dimensional angular movements of the pelvis and lumbar spine using a videoanalysis system, (2) the timing and distance parameters of walking, and (3) pain levels as measured by a visual analogue scale. We found that to walk faster, those with acute low back pain increased stride length and the frontal plane movements of pelvic list and lumbar lateral flexion (pelvis) to a greater extent than when symptoms had resolved. We also found that 10 min of treadmill walking at self-selected speed led to a reduction in the level of back pain and that there was a high degree of negative correlation between level of back pain and stride length. An additional 5 min of fast walking did not lead to any further changes in level of back pain. These findings support clinical recommendations that the moderate physical activity of walking may be beneficial in the management of people with acute low back pain. To walk faster, people with acute low back pain may utilise strategies that had been limited at self-selected speed, without any increase in pain.     

Management of facet joints osteoarthritis associated with chronic low back pain: A systematic review

IntroductionFacet joint injections (FJI) and medial branch blocks (MBB) can be employed for chronic low back pain (LBP) using different drugs such as corticosteroids, hyaluronic acid, sarapin and local anaesthetics. This systematic review compares the results of injections obtained with different compounds in the management LBP originating from facet joints.MethodsThe present systematic review was conducted according to the PRISMA statement. The literature search was performed in October 2020. All the randomized clinical trials concerning injection treatments for chronic LBP. Drugs rather than steroids, hyaluronic acid, anaesthetics and sarapin were not considered, as well as those reporting outcomes from combined treatments. The Oswestry Disability Index (ODI) and the numeric rating scale (NRS) were retrieved.ResultsData from 587 patients were retrieved. The mean follow-up was 12.4 ± 10.5 months. The mean age was 51.3 ± 9.6 years old. 57% (335/587) of patients were women. Steroids promoted a reduction of NRS by 28% (P < 0.0001) and an improvement of the ODI by 13.2% (P = 0.005), and local anaesthetics produced an improvement of the ODI by 9.8% (P < 0.0001). Sarapin resulted in a reduction of NRS by 44% (P = 0.04) and an improvement the ODI by 14.9% (P = 0.004); sarapin combined with steroids promoted a reduction of NRS by 47% (P = 0.04) and an improvement of the ODI by 11.7% (P = 0.001).ConclusionInjections for chronic LBP deriving from facet joints osteoarthritis are encouraging, especially when considering MBB.Level of evidenceI, systematic review of RCTs.     

Danish version of the Oswestry Disability Index for patients with low back pain. Part 1: Cross-cultural adaptation, reliability and validity in two different populations

Over the past 10 years, a plethora of back-specific patient-orientated outcome measures have appeared in the literature. Standardisation has been advocated by an expert panel of researchers proposing a core set of instruments. Of the condition-specific questionnaires the Oswestry Disability Index (ODI) is recommended for use with low back pain (LBP) patients. To date, no Danish version of the ODI exists which has been cross-culturally adapted, validated and published in the peer-reviewed literature. A cross-cultural adaptation and validation of the ODI for the Danish language was carried out according to established guidelines: 233 patients [half of the patients were seen in the primary sector (PrS) and half in the secondary sector (SeS) of the Danish health care system] with LBP and/or leg pain completed a questionnaire booklet at baseline, 1 day or 1 week and 8 weeks follow-up. The booklet contained the Danish version of the ODI, along with the Roland Morris Disability Questionnaire, the LBP Rating Scale, the SF36 (physical function and bodily pain scales) and a global pain rating. For the ODI test–retest analysis (93 stable patients) resulted in an intraclass correlation coefficient of 0.91, a mean difference of 0.8 and 95% limits of agreements of − 11.5 to + 13. Thus, a worsening greater than 12 points and improvement greater than 13 points can be considered a “real” change above the measurement error. A substantial floor effect was found in PrS patients (14.1%). The ODI showed satisfactory cross-sectional discriminant validity when compared to the external measures. Concurrent validity of the ODI revealed: (a) a 10% and 21% lower ODI score compared to the disability and pain measures, respectively, (b) a poorer differentiation of patient disabilities and (c) an acceptable individual ODI score level compared to the external measures. Longitudinal external construct validity showed moderate correlations (range 0.56–0.78). We conclude that the Danish version of the ODI is both a valid and reliable outcome instrument in two LBP patient populations. The ODI is probably most appropriate for use in SeS patients.Part 2 of this article is available at:     

Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire

Several versions of the 24-item Roland Morris Disability Questionnaire (RMDQ) have been proposed; however, their responsiveness has not been extensively explored. The objective of this study was to compare the responsiveness of four versions of the RMDQ. Perceived disability was measured using the 24-item, two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six randomised controlled trials. Responsiveness was calculated using effect size, Guyatt’s responsiveness index (GRI) and receiver operating characteristics (ROC) curves. Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ. GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item. ROC curves revealed that the 11-item was less responsive than the other three versions, which had similar responsiveness. The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item.     

Sitting and low back pain: the positive effect of rotatory dynamic stimuli during prolonged sitting

In this study the effect of dynamic stimuli on low back pain during prolonged sitting was investigated. The pain experience of two groups of 60 subjects with aspecific low back pain was recorded. All subjects were investigated on pain behaviour by the Multidimensional Pain Inventory (MPI) and pain was measured on an open visual analogue scale (VAS). During sitting, one group received dynamic stimuli that were generated by alternating rotations in the horizontal plane of the seat of the chair, with back and arm rests in fixed position. Two different frequencies of rotation were applied in subgroups. The authors concluded that such stimuli, especially of the lower frequency, reduced pain in prolonged sitting. Received: 8 May 1998 Revised: 23 November 1998 Accepted: 28 December 1998     

The Italian version of the Quebec Back Pain Disability Scale: cross-cultural adaptation,reliability and validity in patients with chronic low back pain

European Spine Journal - Growing attention is being given to physical functioning measures to assess interventions for low back pain (LBP). The Quebec Back Pain Disability Questionnaire (QBPDS) has...     

汉译Roland-Morris功能障碍调查表评估下腰痛患者的可靠性

目的:探讨应用汉译Roland-Morris功能障碍调查表评定下腰痛患者的可靠性。方法:将Roland-Morris功能障碍调查表按一定的要求翻译成中文调查表(CRMDQ),对48例住院拟手术的下腰痛患者(男30例,女18例;年龄26～73岁,平均38.5岁),用CRMDQ、中文版Oswestry功能障碍指数(CODI)、视觉模拟评分(VAS)先后进行两次测试,间隔期2d,检测CRMDQ的可重复性;对门诊158例下腰痛患者在就诊时行CRMDQ、CODI、VAS测试,对CRMDQ与CODI、VAS测试结果进行Spearman秩相关分析。结果:CRMDQ具有良好的可重复性(r=0.945,P<0.01);在CRMDQ有效性测试中,与CODI、VAS比较显示出显著的相关性(CRMDQ-CODI:r=0.386;CRMDQ-VAS:r=0.478,P<0.05)。结论:CRMDQ测试具有良好的可重复性和有效性,可用于对下腰痛患者的功能障碍评估。     

Outcome measures in chronic low back pain

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland–Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a “successful” outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution- and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution.     

How is recovery from low back pain measured? A systematic review of the literature

Recovery is commonly used as an outcome measure in low back pain (LBP) research. There is, however, no accepted definition of what recovery involves or guidance as to how it should be measured. The objective of the study was designed to appraise the LBP literature from the last 10 years to review the methods used to measure recovery. The research design includes electronic searches of Medline, EMBASE, CINAHL, Cochrane database of clinical trials and PEDro from the beginning of 1999 to December 2008. All prospective studies of subjects with non-specific LBP that measured recovery as an outcome were included. The way in which recovery was measured was extracted and categorised according to the domain used to assess recovery. Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs. There were nine single-item recovery rating scales. Eleven studies used a global change scale that included an anchor of ‘completely recovered’. Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance. In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently. This lack of consistency makes interpretation and comparison of the LBP literature problematic. It is likely that the failure to use a standardised measure of recovery is due to the absence of an established definition, and highlights the need for such a definition in back pain research.     

Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function

Introduction

Various studies have shown that spine stabilisation exercise therapy elicits improvements in symptoms/disability in patients with chronic non-specific low back pain (cLBP). However, few have corroborated the intended mechanism of action by examining whether clinical improvements (1) are greater in patients with functional deficits of the targeted muscles and (2) correlate with post-treatment improvements in abdominal muscle function.

Methods

Pre and directly after 9 weeks’ therapy, 32 cLBP patients (44.0 ± 12.3 years) rated their LBP intensity (0–10) and disability (0–24, Roland–Morris; RM) and completed psychological questionnaires. At the same timepoints, the voluntary activation of transversus abdominis (TrA), obliquus internus and obliquus externus during “abdominal-hollowing” and the anticipatory (“feedforward”) activation of these muscles during rapid arm movements were measured using M-mode ultrasound with tissue Doppler imaging.

Results

Pre-therapy to post-therapy, RM decreased from 8.9 ± 4.7 to 6.7 ± 4.3, and average pain, from 4.7 ± 1.7 to 3.5 ± 2.3 (each P < 0.01). The ability to voluntarily activate TrA increased by 4.5% (P = 0.045) whilst the anticipatory activation of the lateral abdominal muscles showed no significant change (P > 0.05). There was no significant correlation between the change in RM scores after therapy and either baseline values for voluntary (r = 0.24, P = 0.20) or anticipatory activation (r = 0.04, P = 0.84), or their changes after therapy (voluntary, r = 0.08, P = 0.66; anticipatory, r = 0.16, P = 0.40). In multiple regression, only a reduction in catastrophising (P = 0.0003) and in fingertip–floor distance (P = 0.0006) made unique contributions to explaining the variance in the reduction in RM scores.

Conclusion

Neither baseline lateral abdominal muscle function nor its improvement after a programme of stabilisation exercises was a statistical predictor of a good clinical outcome. It is hence difficult to attribute the therapeutic result to any specific effects of the exercises on these trunk muscles. The association between changes in catastrophising and outcome serves to encourage further investigation on larger groups of patients to clarify whether stabilisation exercises have some sort of “central” effect, unrelated to abdominal muscle function per se.