ix
TABLE OF CONTENTS 1
DIRECTIONS OF SPINE OUTCOMES RESEARCH ………………………………………………………………1
2
CHOOSING THE RIGHT OUTCOMES INSTRUMENT ……………………………………………………………9
3
STANDARDIZATION AND QUALITY IMPROVEMENT ……………………………………………………… 13
4
QUALITY OUTCOMES MEASURES …………………………………………………………………………… 17
5
CLINICIAN-BASED OUTCOMES MEASURES ………………………………………………………………… 33
6
PATIENT-REPORTED OUTCOMES MEASURES ……………………………………………………………… 39
7 7.1 7.2 7.3.1 7.3.2 7.3.3 7.3.4 7.3.5 7.4 7.5 7.6 7.7 7.8
OUTCOMES MEASURES AND INSTRUMENTS ……………………………………………………………… 45 Function—lumbar-specific ……………………………………………………………………………………… 51 Function—cervical-specific …………………………………………………………………………………… 103 Function—disease-specific—spinal deformity …………………………………………………………… 127 Function—disease-specific—spinal stenosis ……………………………………………………………… 169 Function—disease-specific—osteoporosis ………………………………………………………………… 175 Function—disease-specific—spinal cord injury …………………………………………………………… 195 Function—disease-specific—general neurological ………………………………………………………… 205 Pain …………………………………………………………………………………………………………………211 Disability—physical …………………………………………………………………………………………… 221 Disability—psychosocial ……………………………………………………………………………………… 227 Patient satisfaction …………………………………………………………………………………………… 237 General health ………………………………………………………………………………………………… 243
8
HOW TO APPLY EVIDENCE TO MEDICAL PRACTICE …………………………………………………… 253
9
DEVELOPING OUTCOMES INSTRUMENTS: POINTS TO CONSIDER ………………………………… 257
10
ANALYSIS AND REPORTING OF SPINE OUTCOMES …………………………………………………… 261
11
METHODS FOR IDENTIFYING AND EVALUATING SPINE OUTCOMES MEASURES AND INSTRUMENTS …………………………………………………… 273
LIST OF ASSESSED INSTRUMENTS ………………………………………………………………………………… 280 ABBREVIATIONS ………………………………………………………………………………………………………… 286 GLOSSARY AND DEFINITIONS ……………………………………………………………………………………… 288
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7
OUTCOMES MEASURES AND INSTRUMENTS
7.1
FUNCTION—LUMBAR-SPECIFIC
Func tion
Lumbar-specific Pain Cer vic al-specific Disease -specific Disabilit y (physic al)
Spinal deformit y * Spinal stenosis
Disabilit y (psychosocial)
Osteoporosis Spinal cord injur y
Patient satisfac tion
General neurologic al
General health * Includes ank ylosing disorders, scoliosis, spina bifida.
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7
Outcomes measures and instruments
1
ABERDEEN LOW BACK PAIN SCALE
Also known as Clinical back pain questionnaire.
Source: Ruta DA, Garratt AM, Wardlaw D, Russell IT (1994) Developing a valid and reliable measure of health outcome for patients with low back pain. Spine; 19(17):1887–1896.
Self c are
Type: Patient-reported outcome Scale: 11 categories (19 items)
Each item has a minimum score of 0 and a variable maximum score of 1 to 5.
Leisure
Pain
Sex life Bed/rest Household work ac tivit y
Interpretation:
All items are summed and converted to a percentage. Maximum score: 100 Minimum score: 0
Walking Sensation Sit ting /standing
Streng th Bending / stooping
The higher the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1]
[2]
[3]
• • • • • • • • • • • •
SF-36 Referred pain Analgesic use Current perceived health 42 Roland-Morris disability scale Medical consultation Medication Pain visual analog scale Days absent from work Visits to doctor Medication use Activity level
Patient population tested in
Validity
Reliability
Responsiveness
Patient s with low back pain (N = 568) (43 years; 44% male) [1]
+
+
+
Chinese speaking patient s with low back pain (N = 473) (40 years; 47% male) [2]
+
+
+
Patient s taking par t in exercise study for back pain (N = 187) (age NR; sex NR) [3]
+
NOT T E S T ED
+
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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1
53
Function—lumbar-specific
ABERDEEN LOW BACK PAIN SCALE Validated translation: Chinese
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Ruta DA, Garratt AM, Wardlaw D, et al (1994) Developing a valid and reliable measure of health outcome for patients with low back pain. Spine; 19(17):1887–1896. 2. Leung AS, Lam TH, Hedley AJ, et al (1999) Use of a subjective health measure on Chinese low back pain patients in Hong Kong. Spine; 24(10):961–966.
Validity
3. Garratt AM, Klaber Moffett J, Farrin AJ (2001) Responsiveness of generic and specific measures of health outcome in low back pain. Spine; 26(1):71–77.
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
6
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
1
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
3
TOTAL
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7
Outcomes measures and instruments
2
ACUTE LOW BACK PAIN SCREENING QUESTIONNAIRE (ALBPSQ)
Also known as Orebro musculoskeletal pain screening questionnaire.
Source: Linton SJ, Hallden K (1997) Risk factors and the natural course of acute and recurrent musculoskeletal pain: developing a screening instrument. Paper presented at: Proceedings of the 8th World Congress on Pain, Seattle.
Type: Patient-reported outcome Scale: 8 categories (21 items)
Interpretation: Sleeping
Pain
Anxiet y/depression
Items scored on a scale with a variable minimum of 0, 1, or 2 and a maximum of 10.
Maximum score: 210 Minimum score: 3 The higher the score, the greater the disability.
Household chores Physic al ac tivit y
Shopping Walking Work
OUTCOMES VALIDATED AGAINST
[1]
[2]
[3]
• • • • • • • • • • • • • • • •
Pain Function Sick leave McGill pain questionnaire Roland-Morris disability questionnaire Return to work Number of physical therapy treatments McGill pain questionnaire Roland-Morris disability questionnaire Recurrence of pain Effect on daily activities General health Further treatment Medication Work loss Exercise
Patient population tested in
Validity
Reliability
Responsiveness
Swedish speaking patient s with acute or subacute back pain (N = 137) (43 years; 35% male) [1]
+
NOT T E S T ED
NOT T E S T ED
Irish patient s with low back pain (N = 118) (43 years; 40% male) [2]
+
NOT T E S T ED
NOT T E S T ED
Irish patient s with low back pain (N = 90) (44 years; 37% male) [3]
+
NOT T E S T ED
NOT T E S T ED
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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2
55
Function—lumbar-specific
ACUTE LOW BACK PAIN SCREENING QUESTIONNAIRE (ALBPSQ) Validated translation: Swedish
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Linton SJ, Hallden K (1998) Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain; 14(3): 209–215. 2. Hurley DA, Dusoir TE, McDonough SM, et al (2000) Biopsychosocial screening questionnaire for patients with low back pain: preliminary report of utility in physiotherapy practice in Northern Ireland. Clin J Pain; 16(3):214–228. 3. Hurley DA, Dusoir TE, McDonough SM, et al (2001) How effective is the acute low back pain screening questionnaire for predicting 1-year follow-up in patients with low back pain? Clin J Pain; 17(3):256–263.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
-
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
-
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
-
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
-
-
1
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
1
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
3
TOTAL
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7
3
Outcomes measures and instruments
BACK ILLNESS PAIN AND DISABILITY SCALE (BACKILL)
Adapted from the McGill pain questionnaire, Functional assessment screening questionnaire (FASQ) and Oswestry disability questionnaire.
Source: Tesio L, Granger CV, Fiedler RC (1997) A unidimensional pain/disability measure for low-back pain syndromes. Pain; 69(3):269–278.
Type: Patient-reported outcome Scale: 6 categories ( 9 items)
Additional items fearful and punishing-cruel present, but not included in fi nal score. Each item scored on a 1 to variable maximum of 4 to 6 point scale.
Interpretation:
Pain Self c are Lif ting
Maximum score: 44 Minimum score: 9 Raw score can be converted to a 100 point scale.
Walking
Sit ting /standing Traveling
The lower the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1]
• Improvement in well being • Hypothesized back pain symptoms
and dysfunction
Patient population tested in
Italian speaking patient s with chronic low back pain (N = 32) (44 years; 63% male) [1]
Validity
Reliability
Responsiveness
+
+
+
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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3
57
Function—lumbar-specific
BACK ILLNESS PAIN AND DISABILITY SCALE (BACKILL) Validated translation: Italian
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Tesio L, Granger CV, Fiedler RC (1997) A unidimensional pain/ disability measure for low-back pain syndromes. Pain; 69(3):269–278.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
-
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
-
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
4
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
2
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
4
TOTAL
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58
7
Outcomes measures and instruments
4
BACK PAIN FUNCTIONAL SCALE (BPFS)
Source: Stratford PW, Binkley JM, Riddle DL (2000) Development and initial validation of the back pain functional scale. Spine; 25(16):2095–2102.
Type: Patient-reported outcome Scale: 12 categories (12 items)
Each item preceded by “any difficulty because of your back problem.” Each item scored on a 0 to 5 point scale.
Driving Stairs
Work ( job, house, school) Leisure
Walking
Household chores
Self c are
Bending /stooping
Sleeping
Interpretation:
Maximum score: 60 Minimum score: 0 The lower the score, the greater the disability.
Lif ting
Standing
Sit ting
OUTCOMES VALIDATED AGAINST
[1]
[2]
• • • • • • • • • • • • •
Roland-Morris disability questionnaire Work status Location of symptoms Education level Smoking status Roland-Morris disability questionnaire Work status Location Extensor hallucis longus weakness Straight leg raise Crossed straight leg raise Education level Smoking status
Patient population tested in
Validity
Reliability
Responsiveness
Patient s with low back pain (N = 77) (44 years; 39% male) [1]
+
+
+
Patient s with low back pain (N = 153) (age NR; 43% male) [2]
+
+
+
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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7.1
4
59
Function—lumbar-specific
BACK PAIN FUNCTIONAL SCALE (BPFS)
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Stratford PW, Binkley JM, Riddle DL (2000) Development and initial validation of the back pain functional scale. Spine; 25(16):2095–2102. 2. Stratford PW, Binkley JM (2000) A comparison study of the back pain functional scale and Roland Morris Questionnaire. North American Orthopaedic Rehabilitation Research Network. J Rheumatol; 27(8):1928–1936.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
6
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
1
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
3
TOTAL
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7
Outcomes measures and instruments
5
BACK PERFORMANCE SCALE (BPS)
Source: Strand LI, Moe-Nilssen R, Ljunggren AE (2002) Back Performance Scale for the assessment of mobility-related activities in people with back pain. Phys Ther; 82(12):1213–1223.
Type: Clinician-based outcome Scale: 5 items relating to physi-
cal performance of compound activities. Each item scored on a 0 to 3 point scale.
Lif t test: while standing repeat lif ting a 5 k g box from the floor to a table
F inger tip -to -floor test: while standing reach toward the floor with finger tips
Sock test: while sit ting with knees bent grab the toes with finger tips
Pick-up test: pick up a piece of paper from the floor
Interpretation:
Maximum score: 15 Minimum score: 0 The higher the score, the greater the disability.
Roll-up test: supine position to long-sit ting position
OUTCOMES VALIDATED AGAINST
[1]
[2]
• • • • • •
Patients with back pain Patients with neck or shoulder pain Activity limitations Return to work Roland-Morris disability questionnaire Hannover functional ability questionnaire
Patient population tested in
Validity
Reliability
Responsiveness
Patient s with back pain (N = 114) (44 years; 40% male) [1]
+
+
+
Patient s with chronic low back pain (N = 32) (38 years; 34% male) [2] Patient s with acute low back pain (N = 9) (46 years; 89% male) [2]
+
+
NOT T E S T ED
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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5
61
Function—lumbar-specific
BACK PERFORMANCE SCALE (BPS)
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Strand LI, Moe-Nilssen R, Ljunggren AE (2002) Back Performance Scale for the assessment of mobility-related activities in people with back pain. Phys Ther; 82(12):1213– 1223. 2. Magnussen L, Strand LI, Lygren H (2004) Reliability and validity of the back performance scale: observing activity limitation in patients with back pain. Spine; 29(8):903–907.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
-
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
5
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
2
Clinician friendliness
LIMITED
MODERATE
STRONG
0
SUBTOTAL
2
TOTAL
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7
Outcomes measures and instruments
6
BOURNEMOUTH QUESTIONNAIRE (BQ)
Source: Bolton JE, Breen AC (1999) The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther; 22(8):503–510.
Type: Patient-reported outcome Scale: 5 categories (7 items)
Each item scored on a 0 to 10 point scale.
Interpretation:
Pain
Work
Total score is the sum of all items. Maximum score: 70 Minimum score: 0
Anxiet y/ depression
General ac tivit y
Leisure
The higher the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1]
[2]
[3]
• • • • • • • • • • •
Chronic pain questionnaire Modified somatic pain questionnaire Zung self-rating depression scale Pain locus of control questionnaire Revised Oswestry questionnaire Sick leave Recurrence of pain Disabling pain Persistent pain Roland-Morris disability questionnaire SF-36
Patient population tested in
Validity
Reliability
Responsiveness
Patient s with back pain (N = 55) (46 years; 49% male) [1]
+
NOT T E S T ED
+
Patient s with back pain (N = 82) (50 years; 46% male) [1]
+
+
NOT T E S T ED
Nor wegian speaking patient s with low back pain (N = 875) (age NR; sex NR) [2]
-
NOT T E S T ED
NOT T E S T ED
Danish speaking patient s with low back pain (N = 73) (age NR; 59% male) [3]
+
+
+
NOT T E S T ED
NOT T E S T ED
+
Patient s with back pain (N = 165) (41 years; 51% male) [4]
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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63
Function—lumbar-specific
BACK BOURNEMOUTH QUESTIONNAIRE (BQ) Validated translation: Danish
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Bolton JE, Breen AC (1999) The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther; 22(8):503–510. 2. Larsen K, Leboeuf-Yde C (2005) The Bournemouth Questionnaire: can it be used to monitor and predict treatment outcome in chiropractic patients with persistent low back pain? J Manipulative Physiol Ther; 28(4):219–227. 3. Hartvigsen J, Lauridsen H, Ekstrom S, et al (2005) Translation and validation of the danish version of the Bournemouth questionnaire. J Manipulative Physiol Ther; 28(6):402–407. 4. Hurst H, Bolton J (2004) Assessing the clinical signifi cance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther; 27(1):26–35.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
0
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
5
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
2
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
4
TOTAL
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7
7
Outcomes measures and instruments
CLINICAL OVERALL SCORE (COS)
Source: Graver V, Ljunggren AE, Malt UF, Loeb M, Haland AK, Magnaes, Lie H (1995) Can psychological traits predict the outcome of lumbar disc surgery when anamnestic and physiological risk factors are controlled for? Results of a prospective cohort study. J Psychosom Res; 39(4):465–476.
Type: Clinician-based outcome Scale: 4 subscales (18 items)
Interpretation:
Analgesic s Pain intensit y
Func tional c apacit y
Clinical overall score is the weighted sum of the 4 subscales. Pain score is quadrupled and the other 3 scores are doubled.
Physic al signs
Maximum score: 1000 Minimum score: 0 The higher the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1]
• Patient’s opinion of outcome and
Patient population tested in
return to work • Examiner’s opinion of outcome and return to work
Patient s following first time lumbar disc surger y (N = 122) (41 years; 54% male) [1]
Validity
Reliability
Responsiveness
+
+
+
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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7
65
Function—lumbar-specific
CLINICAL OVERALL SCORE (COS)
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Graver V, Loeb M, Rasmussen F, et al (1998) Clinical overall score: outcome evaluation after lumbar disc surgery, assessments of reliability and validity. Scand J Rehabil Med; 30(4):227–233. Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
-
Construct validity
NOT TESTED
NOT VALID
VALID
-
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
-
1
3
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
1
Clinician friendliness
LIMITED
MODERATE
STRONG
0
SUBTOTAL
1
TOTAL
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66
7
8
Outcomes measures and instruments
CORE LOW BACK PAIN OUTCOME MEASURE
Source: Deyo RA, Battie M, Beurskens AJ, et al (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine; 23(18):2003–2013.
Type: Patient-reported outcome Scale: 6 categories (6 items)
Each item scored on a 1 to 5 point scale.
Satisfac tion
Back specific func tion
Interpretation:
All items linearly transformed into 0 to 10 point scale. General health status
Pain (back and leg separately)
Social disabilit y
Work disabilit y
Items are averaged to form a composite core index ranging from 0 to 10. The higher the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1]
• Roland-Morris disability questionnaire • WHO quality of life physical subscale • Surgical versus conservative treated
patient group
Patient population tested in
German speaking patient s with low back pain (N = 277) (56 years; 45% male) [1]
Validity
Reliability
Responsiveness
+
+
+
VALIDATION STUDIES
1. Mannion AF, Elfering A, Staerkle R, et al (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J; 14(10):1014–1026.
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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Function—lumbar-specific
CORE LOW BACK PAIN OUTCOME MEASURE Validated translation: German
MODIFIED VERSIONS
METHODOLOGICAL EVALUATION
Modified core low back pain outcome measure
Used visual analog scale (VAS) instead of Likert scale, added “school” and “running the household” to the work disability item as possible work options. Source: Mannion AF, Elfering A, Staerkle R, et al (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J; 14(10):1014–1026.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
6
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
2
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
4
TOTAL
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68
7
Outcomes measures and instruments
9
EXTENDED ABERDEEN SPINE PAIN SCALE
Extended the Aberdeen low back pain scale to include the whole spine.
Source: Williams NH, Wilkinson C, Russell IT (2001) Extending the Aberdeen Back Pain Scale to include the whole spine: a set of outcome measures for the neck, upper and lower back. Pain; 94(3):261–274.
Type: Patient-reported outcome Scale: 3 spinal regions,
1 general pain category (31 items)
Low back /lumbar
General pain
The general pain questions are not spinal region specific. Each item has a minimum score of 0 and a variable maximum score of 1 to 5.
Interpretation:
Scales can be combined for a whole spine score or scored for individual regions of the spine.
Upper back /thoracic Neck /cer vic al
All items are summed and converted to a percentage. Maximum whole spine and spinal region score: 100 Minimum whole spine and spinal region score: 0 The higher the score, the greater the disability.
OUTCOMES VALIDATED AGAINST
[1] [2]
Health status changes SF-12 health profi le Total health score Hannover functional ability questionnaire • SF-36 • • • •
Patient population tested in
Patient s with back pain (N = 512) (45 years; 36% male) [1] Patient s with low back pain (N = 78) (age NR; sex NR) [1] German speaking patient s with spinal pain (N = 158) (48 years; 73% male) [2]
Validity
Reliability
Responsiveness
+
+
+
NOT T E S T ED
-
NOT T E S T ED
+
+
+
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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9
69
Function—lumbar-specific
EXTENDED ABERDEEN SPINE PAIN SCALE Validated translation: German
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Williams NH, Wilkinson C, Russell IT (2001) Extending the Aberdeen Back Pain Scale to include the whole spine: a set of outcome measures for the neck, upper and lower back. Pain; 94(3):261–274. 2. Osthus H, Cziske R, Jacobi E (2006) A German version of the Extended Aberdeen Back Pain Scale: development and evaluation. Spine; 31(5):571–577.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
6
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
1
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
3
TOTAL
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70
7
Outcomes measures and instruments
10
FUNCTIONAL RATING INDEX (FRI)
Source: Feise RJ, Michael Menke J (2001) Functional rating index: a new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine; 26(1):78–86.
Type: Patient-reported outcome Scale: 10 subscales (10 items)
Each subscale contains five statements. Each statement describes a greater degree of disability.
Standing
Pain intensit y
Walking
Sleeping
Lif ting
Self c are
Pain frequenc y
Interpretation:
Total score is normalized to 100. Maximum score: 100 Minimum score: 0
Travel
Recreation
Work
The higher the score, the greater the disability.
Each subscale scored on a 0 to 4 point scale.
OUTCOMES VALIDATED AGAINST
[1]
[2]
• • • •
[3]
•
[4]
• • • •
Disability rating index SF-12 physical component score SF-12 mental component score Modified Oswestry low back pain disability questionnaire 18-item Roland-Morris disability questionnaire Improvement with time Change in work status Roland-Morris disability questionnaire Numeric rating scale
Patient population tested in
Validity
Reliability
Responsiveness
Patient s with spinal complaint s (N = 139) (41 years; 40% male) [1]
+
+
+
Patient s with low back pain (N = 131) (34 years; 58% male) [2]
+
-
+
Patient s with work-related low back pain (N = 143) (38 years; 73% male) [3]
+
+
+
Turkish speaking patient s with chronic low back pain (N = 37) (76 years; 36% male) [4]
+
+
NOT T E S T ED
SPINE OUTCOMES MEASURES AND INSTRUMENTS
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Function—lumbar-specific
FUNCTIONAL RATING INDEX (FRI) Validated translation: Turkish
VALIDATION STUDIES
METHODOLOGICAL EVALUATION
1. Feise RJ, Michael Menke J (2001) Functional rating index: a new valid and reliable instrument to measure the magnitude of clinical change in spinal conditions. Spine; 26(1):78–86. 2. Childs MJ, Piva SR (2005) Psychometric properties of the functional rating index in patients with low back pain. Eur Spine J; 14(10):1008–1012. 3. Chansirinukor W, Maher CG, Latimer J, et al (2005) Comparison of the functional rating index and the 18-item RolandMorris Disability Questionnaire: responsiveness and reliability. Spine; 30(1):141–145. 4. Bayar B, Bayar K, Yakut E, et al (2004) Reliability and validity of the Functional Rating Index in older people with low back pain: preliminary report. Aging Clin Exp Res; 16(1):49–52.
Validity
NO SCORE
0 POINTS
1 POINT
POINTS
Content validity
NOT TESTED
NOT VALID
VALID
1
Construct validity
NOT TESTED
NOT VALID
VALID
1
Criterion validity
NOT TESTED
NOT VALID
VALID
1
Internal consistency
NOT TESTED
NOT CONSISTENT
CONSISTENT
1
Reproducibility
NOT TESTED
Responsiveness
NOT TESTED
Reliability
NOT REPRODUCIBLE REPRODUCIBLE
NOT RESPONSIVE
RESPONSIVE
SUBTOTAL
1
1
6
CLINICAL UTILITY 0 POINTS
1 POINT
2 POINTS
POINTS
Patient friendliness
LIMITED
MODERATE
STRONG
2
Clinician friendliness
LIMITED
MODERATE
STRONG
2
SUBTOTAL
4
TOTAL
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