title: Development and Initial Validation of the Back Pain Functional Scale Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Computed tomography findings 4 years after surgical management of lumbar spinal stenosis. No correlation with clinical outcome. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Is Work Status of Low Back Pain Patients Best Described by an Automated Device or by a Questionnaire? Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? Is a Condition-Specific Instrument for Patients with Low Back Pain/Leg Symptoms Really Necessary?: The Responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36 The clinical importance of changes in outcome scores after treatment for chronic low back pain Responsiveness of common outcome measures for patients with low back pain. A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. Assessing change over time in patients with low back pain. Isokinetic Measurement of Trunk Muscle Strength in Women with Chronic Low-Back Pain Lumbar spine range of motion as a measure of physical and functional impairment: an investigation of validity Assessing Health‐Related Quality of Life in Patients With Sciatica Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain. Function and the patient with chronic low back pain. The Reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the Assessment of Patients With Lumbar Spinal Stenosis A Prospective Study of Work Perceptions and Psychosocial Factors Affecting the Report of Back Injury The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. The Quebec Task Force Classification for Spinal Disorders and the Severity, Treatment, and Outcomes of Sciatica and Lumbar Spinal Stenosis Standardized evaluation of long-term results after anterior lumbar interbody fusion Simplifying Outcome Measurement: Evaluation of Instruments for Measuring Outcome After Fusion Surgery for Chronic Low Back Pain Cross-Cultural Adaptation of the Lumbar North American Spine Society Questionnaire for Italian-Speaking Patients With Lumbar Spinal Disease Functional Rating Index: A New Valid and Reliable Instrument to Measure the Magnitude of Clinical Change in Spinal Conditions A Comparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervical Spine Pain The General Function Score: a useful tool for measurement of physical disability. Validity and reliability Predictors of time loss after back injury in nurses. Responsiveness of functional status in low back pain: a comparison of different instruments Lumbar spinal stenosis: assessment of long-term outcome 12 years after operative and conservative treatment. Assessment of Outcome in Patients with Low‐Back Pain Use of a subjective health measure on Chinese low back pain patients in Hong Kong. Low Back Pain Rating scale: validation of a tool for assessment of low back pain A unidimensional pain/disability measure for low-back pain syndromes Symptoms, signs, and functional disability in adult spondylolisthesis. The Reliability of the Low Back Outcome Score for Back Pain Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up A New Approach to the Measurement of Quality of Life: The Patient‐Generated Index Variability of outcome after lumbar disc surgery. Predicting Poor Outcomes for Back Pain Seen in Primary Care Using Patients' Own Criteria Coordination of Primary Health Care for Back Pain: A Randomized Controlled Trial Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability Predicting long-term functional limitations among back pain patients in primary care settings. Psychological distress deteriorates the subjective outcome of lumbosacral fusion. A prospective study.
abstract: Study Design . A prospect i ve repeated- measures design was applied . Objectives . To examine the measurement properties of the Back Pain Functional Scale ( BPFS ) and the Rol and –Morris Question naire ( RMQ )  and to formulate hypotheses and sample size estimates for a subsequent comparison study . Summary of Background Data . Although there are numerous functional status measures for patients with low back pain , most have been conceived of and vali date d with a group rather than an individual patient as the unit of interest . Also , little has been done to formally compare — this includes the generation of a priori hypotheses , followed by statistical hypotheses testing — the many competing measures . Methods . Subjects were 77 patients with low back pain who were referred by physicians to 10 outpatient physical therapy clinics located in Canada and the United States . The question naires were administered at patients ’ initial visits , within 48 hours of the initial visit , and at 1- , 2- , and 3-week follow-up visits . Reliability , cross-sectional validity , and longitudinal validity ( sensitivity to change ) coefficients were calculated . Results . Test – retest reliability estimates of 0.81 and 0.88 were obtained for the RMQ and BPFS , respectively . The measures demonstrated similar levels of cross-sectional validity . Correlations of 0.56 and 0.65 were noted between a prognostic rating of change and the RMQ and BPFS , respectively . The RMQ demonstrated a ceiling effect .  Approximately 180 patients are needed for a subsequent head-to-head comparison study of the measures . Conclusions . The BPFS appears to have sound measurement properties , and a formal head-to-head comparison study with the RMQ is warranted Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) ,  Oswestry Disability Index ( ODI ) ,  Disability Rating Index ( DRI ) , and  Physical Functioning scale of the SF-36 ( PFSF-36 ) , and two  pain scales , a  Numerical Pain Rating Scale ( NRS ) and  Visual Analogue Scale ( VAS ) .  Summary of Background Data . Concurrent comparisons of different outcome measurements in back patients have been requested . Methods .  Norwegian versions of the scales and question naires  were completed by 54 patients with acute ( < 3weeks ) and 50 patients with chronic low back pain ( > 3 months ) . Clinical change was estimated on a global change index . An alternative external criterion was the expected clinical course in the two cohorts . Mean changes , st and ardized response mean ( SRM ) , and area under the receiver operating characteristic ( ROC ) curves with cutoff point for highest sensitivity and specificity were calculated . Results . At the follow-up , 63 % of the acute and 41 % of the chronic sample reported improvement on the global change index . Large SRMs ( 1.3–2.0 ) and areas under the ROC curves ( 0.84–0.93 ) were found for the measurements in the acute sample . In the chronic sample , the SRMs ( 0.4–1.1 ) and areas under the ROC curves ( 0.65–0.83 ) were lower , in particular for the PFSF-36 and the VAS . There was no statistically significant difference between the responsiveness in the measurements , except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change . Conclusion . The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain , whereas among chronic patients the RMDQ , ODI , DRI , and NRS were most appropriate BACKGROUND Chronic low-back pain is a significant public health problem for which few therapies are supported by predictable outcomes . In this report , practice activities and 1-month outcomes data are presented for 93 chiropractic patients and 45 medical patients with chronic , recurrent low-back pain . DESIGN A prospect i ve , observational , community-based feasibility study involving chiropractors and family medicine physicians . SETTING Forty private chiropractic clinics , the outpatient clinic of the Department of Family Medicine at Oregon Health Sciences University , and 5 other Portl and area family medicine clinics . OUTCOMES MEASURES The main outcome measures were pain severity , functional disability , sensory and affective pain quality at 1 month , and patient satisfaction assessed at 7 to 10 days and at 1 month . RESULTS Although differences were noted in age , sex , education , and employment , the patients were closely matched at baseline with respect to frequency , severity , and type of low-back pain and the psychosocial dimensions of general health . The treatment of choice for chiropractors was spinal manipulation and physical therapy modalities ; for medical physicians antiinflammatory agents were most frequently used . Chiropractic patients averaged 4 visits , and medical patients averaged 1 visit . On average , chiropractic patients showed improvement across all outcomes : 31 % change in pain severity , 29 % in functional disability , 36 % in sensory pain quality , and 57 % in affective pain quality . Medical patients showed minimal improvement in pain severity ( 6 % ) and functional disability ( 1 % ) and showed deterioration in the sensory ( 29 % ) and affective ( 26 % ) dimensions of pain quality . Satisfaction scores were higher for chiropractic patients . Outcomes for medical patients were heavily dependent on psychosocial status at baseline . CONCLUSION Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians . Non clinical factors may play an important role in patient progress . Findings from the Health Re sources and Services Administration-funded project will include a report on the influence of practice activities , including more frequent visits by chiropractic patients , on the clinical course of low-back pain and patient outcomes . ( J Manipulative Physiol Ther 2000;23:239 - 45 ) STUDY DESIGN A prospect i ve , cross-sectional study of the correlation between postoperative computed tomography findings and patients ' clinical outcomes approximately 4 years after laminectomy for lumbar spinal stenosis . OBJECTIVES To evaluate clinical and radiologic characteristics and their relation to each other . SUMMARY OF BACKGROUND DATA The goal of surgical management for lumbar spinal stenosis is to decompress the stenotic area determined in radiologic examinations to relieve pressure on the neurovascular structures . However , the success of this decompression very rarely has been confirmed by postoperative radiologic imaging or compared with clinical outcome . METHODS Postoperative computed tomography was performed on 191 patients . The findings were classified as " no stenosis , " " central stenosis , " " lateral stenosis , " or " central -lateral stenosis . " Postoperative instability of the lumbar spine was investigated by functional radiography . Clinical status was assessed by clinical examination . Subjective disability was assessing using the Oswestry question naire , and severity of pain using the visual analog scale . Walking capacity was evaluated by the tread-mill test . RESULTS Radiologic studies revealed postoperative stenosis  in 123 patients ( 64 % ) . Small differences between the computed tomography groups were shown for the Oswestry score , but not for walking distance . Clinical signs , severity of pain , and radiologic instability were very similar for all computed tomography groups . CONCLUSIONS Postoperative radiologic stenosis was very common in patients operated on for lumbar spinal stenosis , but this did not correlate with clinical outcome . The clinician must be cautious when reconciling clinical symptoms and signs with postoperative computed tomography findings in patients operated on for lumbar spinal stenosis STUDY DESIGN A double-blind , r and omized controlled trial of a novel educational booklet compared with a traditional booklet for patients seeking treatment in primary care for acute or recurrent low back pain . OBJECTIVE To test the impact of a novel educational booklet on patients ' beliefs about back pain and functional outcome . SUMMARY OF BACKGROUND DATA The information and advice that health professionals give to patients may be important in health care intervention , but there is little scientific evidence of their effectiveness . A novel patient educational booklet , The Back Book , has been developed to provide evidence -based information and advice consistent with current clinical guidelines . METHODS One hundred sixty-two patients were given either the experimental booklet or a traditional booklet . The main outcomes studied were fear-avoidance beliefs about physical activity , beliefs about the inevitable consequences of back trouble , the Rol and Disability Question naire , and visual analogue pain scales . Postal follow-up response at 1 year after initial treatment was 78 % . RESULTS Patients receiving the experimental booklet showed a statistically significant greater early improvement in beliefs which was maintained at 1 year . A greater proportion of patients with an initially high fear-avoidance beliefs score who received the experimental booklet had clinical ly important improvement in fear-avoidance beliefs about physical activity at 2 weeks , followed by a clinical ly important improvement in the Rol and Disability Question naire score at 3 months . There was no effect on pain . CONCLUSION This trial shows that carefully selected and presented information and advice about back pain can have a positive effect on patients ' beliefs and clinical outcomes , and suggests that a study of clinical ly important effects in individual patients may provide further insights into the management of low back pain Study Design . A prospect i ve cohort study of patients with subacute occupational back pain . Objectives . To study the relation between a marketed opto‐electric device measuring trunk kinematics , a widely used specific functional capacity question naire , and work status in back pain patients , and to assess the responsiveness to change in work status of the opto‐electric device and the question naire . Summary of Background Data . Several instruments have been developed to evaluate the functional capacities of patients with back pain , but the relation between these instruments and work status has rarely been studied . Methods . The relation between the opto‐electric device , the question naire , and work status in patients with back pain was evaluated . The study population was a prospect i ve cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks . All data were compiled blindly on the same day , at study entry ( 4 weeks after work accident ) , and at 12 , 24 , and 52 weeks after the work accident . The validity of the question naire and opto‐electric device scores was assessed with partial correlation analyses , st and ardized response mean , logistic regression analyses , and receiver operating characteristics curves . Results . The correlation between the question naire and opto‐electric device scores was low . The question naire scores were significantly related to work status , but the opto‐electric device scores were not . The question naire was responsive to change in work status , whereas the opto‐electric device was not . Conclusions . The opto‐electric device scores were not related to either functional capacity scores ( question naire ) or work status in patients with low back pain , and the opto‐electric device was not responsive to change in work status . Conversely , the question naire was related to work status and was responsive to change in work status OBJECTIVE Previous studies have shown that cortical-evoked potentials on magnetic stimulation of muscles are influenced by muscle contraction , vibration , and muscle spasm . This study was carried out to determine whether these potentials correlate with palpatory muscle spasm , patient symptoms , and disability in patients with low back pain . METHODS A prospect i ve observational study was performed on 13 subjects with a history of low back pain visiting an orthopedic hospital-based clinic . Patients were screened for serious pathologic conditions by an orthopedic surgeon . The patients were then evaluated for the presence of muscle spasm by one of the investigators who was blinded to the results of the evoked potential studies . Patients were asked to complete a  low back pain visual analogue scale ( VAS ) and a Rol and -Morris Activity Scale ( RMAS ) . Cortical-evoked potentials were recorded with a magnetic stimulator placed over the lumbar paraspinal muscles with the patient in the prone position . The palpatory examination , VAS , RMAS , and the cortical potentials were repeated after 2 weeks of therapy commonly used to reduce muscle spasm . RESULTS The patients demonstrated a significant decrease in low back pain VAS and RMAS scores after treatment compared with before treatment . There was a reduction in the amount of palpatory muscle spasm in 11 of 13 cases . The cortical potentials before treatment were attenuated compared with previously reported controls and showed a significant increase before and after treatment in the amplitude of these potentials with multivariate analysis of variance . There was significant correlation between the changes in cortical potentials after treatment and the changes noted in paraspinal muscle spasm and VAS and RMAS scores . CONCLUSIONS This study confirms the previous report that the amplitude of cerebral-evoked potentials on magnetic stimulation of paraspinal muscles is depressed in the presence of palpable muscle spasm . The close correlation among these potentials , paraspinal muscle spasm , and clinical symptoms suggests that the measurement of muscle activity may be more important in the assessment of low back pain than is commonly accepted Study Design . Analysis of longitudinal data collected prospect ively from patients seen in 27 National Spine Network member centers across the United States . Objective . To evaluate the responsiveness of the Oswestry Disability Index , MODEMS scales , and all scales and summary scales of the MOS Short-Form 36 ( SF-36 ) for patients with low back pain/leg symptoms . Summary of Background Data . The responsiveness of general and condition-specific health status instruments is a key concept for clinicians and scientists . Various authors have explored responsiveness in common surveys used to assess spine patients . Although it is generally believed that condition-specific measures are more responsive to change in the condition under study , in the case of low back pain , most authors agree that further exploration is necessary . Methods . Patients with diagnoses of herniated disc , spinal stenosis , and spondylosis from the National Spine Network data base who completed baseline and 3-month follow-up surveys were analyzed . Patient-provider consensus regarding improvement , worsening , or no change in the condition was selected as the external criterion . Responsiveness was evaluated using ROC curve analysis and effect size calculations . Results . Nine hundred and seventy patients had complete data at baseline and 3 months . At follow-up , 68 % of the patients had consensus improvement . Based on ROC analysis , scales assessing pain were significantly more responsive than scales assessing function . There were no significant differences between the condition-specific scales and their equivalent general-health counterpart . The scales with the highest probabilities of correctly identifying patient ’s improvement were : the condition-specific pain scale from MODEMS ( PAIN , ROC = 0.758 ) ; the combined pain and function scale from MODEMS ( MPDL , ROC = 0.755 ) ; the general pain scale from the SF-36 ( BP , ROC = 0.753 ) ; the combined pain and function scale from the SF-36 ( PCS , ROC = 0.745 ) ; the condition-specific function measure from the Oswestry ( ODI , ROC = 0.723 ) ; and the physical function measure from the SF-36 ( PF , ROC = 0.721 ) . A similar rank order was typically maintained with effect size calculations . Results were nearly identical in patients with multiple non-spine-related comorbidities and in patients with high degrees of perceived  disability . The BP scale was most responsive to worsening of symptoms . Conclusion . For studies of patients with low back problems , the general SF-36 may be a sufficient measure of health status and patient function , without the need for additional condition-specific instruments .  Pain scales  appear to be the most responsive measures in patients with low back pain Abstract . When measuring treatment effect in chronic low back pain with multi-item outcome instruments , it is necessary , both for clinical decision-making and research purpose s , to underst and the clinical importance of the outcome scores . The aims of the present study were three-fold . Firstly , it aim ed to estimate the minimal clinical ly important difference of three multi-item outcome instruments ( the Oswestry Disability Index , the General Function Score and the Zung Depression Scale )  and of the  visual analogue scale ( VAS ) of back pain .  Secondly , it aim ed to estimate the error of measurement of these instruments ; and its third aim was to describe the clinical meaning of score change . The study population consisted of 289 patients treated surgically or non-surgically in a r and omised controlled trial . The minimal clinical ly important difference was estimated with patient global assessment as the external criterion . It was compared with the st and ard error of measurement of the instruments . The individual items of the instruments were compared for score changes related to improvement and deterioration . The st and ard error of measurement of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale was 4 , 6 and 3 units , respectively . The 95 % tolerance interval was 10 , 16 and 8 units , respectively . The minimal clinical ly important difference was 10 , 12 and 8–9 units , respectively , thus not significantly exceeding the tolerance interval . The minimal clinical ly important difference of VAS back pain was 18–19 units , well exceeding the 95 % tolerance interval , which was 15 units . Improvement after treatment for chronic low back pain tends to occur to a greater extent in sleep disturbance , ability to do usual things and psychological irritability , but to a lesser extent in the ability to sit , st and and lift . We conclude that the VAS of back pain is responsive enough to detect the minimal clinical ly important difference , whereas the smallest acceptable score changes of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale may require an increase to exceed the 95 % tolerance interval when used for clinical decision making and for power calculation . Despite improvement after treatment , the ability to sit , st and and lift , remain notable problems STUDY DESIGN A prospect i ve cohort study assessing the responsiveness of two disease-specific question naires and a generic health question naire for patients with low back pain and sciatica . OBJECTIVES To compare the responsiveness of the eight scales and two summery scales of the SF-36 question naire with that of the Oswestry Disability Index and Low Back Outcome Score question naires . SUMMARY OF BACKGROUND DATA Evaluation of treatment outcome is being determined more frequently from a patient 's perspective , particularly the impact treatment has on current health status . METHODS Patients were recruited from two orthopedic back pain clinics in a tertiary hospital . Patients completed the pretreatment question naire 1 month before treatment and follow-up question naires a minimum of 2 - 6 months after treatment . Patients undergoing surgery were also observed for a minimum of 2 years . RESULTS Overall , the Oswestry Disability Index was most responsive ; however , individual scales from the SF-36 question naire showed equal or greater sensitivity to change than the Oswestry Disability Index in each of the patient subgroups . The SF-36 Role Physical scale was prone to floor effects ( a high percentage of respondents score zero ) , and the change scores from the SF-36 Role Emotional scale varied by 100 points in either direction in each of the patient subgroups . CONCLUSION Responsiveness varied according to which method was used in its calculation . The responsiveness of the SF-36 question naire shows that it can be a useful adjunct in the assessment of patients with low back pain when combined with disease-specific question naires STUDY DESIGN We conducted a prospect i ve study with a 2-year follow-up . OBJECTIVE To compare pain , functional limitations , and work status indices as measures of outcome among back pain patients . SUMMARY OF BACKGROUND DATA Work status , pain , and functional limitations indices are often considered as interchangeable outcome measures in back pain research . This perspective has been criticized by several authors , who argue that each of these outcome measures reflects a different construct that may vary independently of the others . METHODS The study was conducted on 720 patients , who sought care for back pain in primary care setting s of a large health maintenance organization in 1989 - 90 , and were interviewed one month and two years later . X2 analyses and receiver operating characteristic curves were used to compare the accuracy of a pain rating and a modified 16-item Rol and -Morris score in classifying patients on work status and on the change in work status over time . RESULTS Moderate agreement between the pain and functional limitations measures and work status was observed . Pain and functional limitations change scores agreed moderately with improvement in work status , but were poorly associated with decline in work status . CONCLUSIONS Although the pain , functional limitations , and work status indices examined in this study are related , they are not equivalent and should not be regarded as interchangeable . These results argue for a clearer distinction of outcome measures in back pain research BACKGROUND AND PURPOSE This study compared the ability of the Rol and -Morris ( RM ) , Oswestry ( OSW ) , and Jan van Breemen Institute ( JVB ) pain and function question naires to detect change over time . SUBJECTS The sample consisted of 88 patients with mechanical low back pain who were referred by physicians to the outpatient physical therapy department of a teaching hospital . METHODS Question naires were completed by the subjects at their initial visit and 4 to 6 weeks later . Clinical ly important change was estimated by having the subject and the clinician independently complete two rating scales . Sensitivity to change was assessed using receiver operating characteristic ( ROC ) curve analysis . RESULTS The ROC curve areas for the RM ( 0.79 ) , OSW ( 0.78 ) , and JVB pain ( 0.79 ) question naires were significantly greater than for the JVB function question naire ( 0.66 ) . Blank and multiple responses per item were present on approximately 20 % of the OSW question naires and 14 % of the JVB question naires . Words rather than checks were evident on 3 % of the RM question naires . CONCLUSION AND DISCUSSION Based on the latter finding , we believe the RM question naire may be the preferred instrument for assessing change over time in patients with low back pain Bayramoğlu M , Akman MN , Kılınç Ş , Çetin N , Yavuz N , Özker R : Isokinetic measurement of trunk muscle strength in women with chronic low-back pain . Am J Phys Med Rehabil 2001;80:650–655 . Objectives : To investigate the relationships among chronic low-back pain and obesity , total spinal range of motion , and trunk muscle strength . The short-term impact of trunk muscle strengthening exercises on this condition was also examined . Design : A controlled , prospect i ve study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength . The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo , and the control group included 20 age-matched women without known low-back trouble . The Davenport Index was used to calculate the body mass indexes of all subjects . The Oswestry Disability Question naire was used to assess pain in the study group . Full flexion and extension ranges of motion were measured , then isokinetic measurements of trunk muscles were performed at 60- , 120- , and 180-degrees/sec velocities . Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle . Results : Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain ( P < 0.05 ) . After a 15-day st and ard trunk strengthening exercise program in the patient group , trunk muscle strength was found to be increased ( P < 0.05 ) . Conclusions : Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain , and a trunk muscle strengthening program will be helpful in reducing the pain Objective : To investigate the validity of the spinal range of motion models outlined in the second and fourth editions of the American Medical Association Guides to the evaluation of permanent impairment ( AMA Guides ) , for assessing the percentage impairment in chronic low back pain patients . Design : Cross-sectional validation study . Setting : Outpatient department in the Rehabilitation Medicine Unit . Subjects : A volunteer sample of 34 subjects participated in the study , 21 females and 13 males , with a mean age of 47.7 years ( 1 SD = 12.1 ) and 40.1 years ( 1 SD = 11.1 ) , respectively . Subjects had chronic low back with or without leg pain of at least six months ’ duration . Subjects were recruited by medical practitioners and physiotherapists through the Rehabilitation Unit at the Essendon Campus of Royal Melbourne Hospital . Main outcome measures : Lower back range of motion measured with a long arm goniometer and a dual inclinometer , Waddell Physical Impairment Scale , Waddell Disability Index , Oswestry Disability Index . Results : Both range of motion measurement methods demonstrated poor validity and do not bear any consistent relationship to the level of physical or functional impairment in subjects with chronic low back pain . Conclusions : There was no evidence for a relationship between low back range of motion and impairment , and thus it would appear illogical to evaluate impairment in chronic low back pain patients using a spinal range of motion model when aim ing to measure or compensate disability Study Design This study analyzed health-related quality -of-life measures and other clinical and question naire data obtained from the Maine Lumbar Spine Study , a prospect i ve cohort study of persons with low back problems . Objective For persons with sciatica , back pain-specific and general measures of health-related quality -of-life were compared with regard to internal consistency , construct validity , reproducibility , and responsiveness in detecting small changes over a 3-month period . Summary of Background Data Data were collected from 427 participants with sciatica . Baseline in-person interviews were conducted with surgical and medical patients before treatment and by mail at 3 months . Methods  Health-related quality -of-life measures included symptoms ( frequency and bothersomeness of pain and sciatica  ) functional status and well-being ( modified back pain-specific Rol and scale and Medical Outcomes Study 36-item Short Form Health Survey ( SF-36 ) , and disability ( bed rest , work loss , and restricted activity days ) . Results Internal consistency of measures was high . Reproducibility was moderate , as expected after a 3-month interval . The SF-36 bodily pain item and the modified Rol and measure demonstrated the greatest amount of change and were the most highly associated with self-rated improvement . The specific and generic measures changed in the expected direction , except for general health perceptions , which declined slightly . A high correlation between clinical findings or symptoms and the modified Rol and measure , SF-36 , and disability days indicated a high degree of construct validity . Conclusions These measures performed well in measuring the health-related quality -of-life of patients with sciatica . The modified Rol and and the physical dimension of the SF-36 were the measures most responsive to change over time , suggesting their use in prospect i ve evaluation . Disability day measures , although valuable for assessing the societal impact of dysfunction , were less responsive to changes over this short-term follow-up of 3 months Abstract Failed back surgery syndrome ( FBSS ) is an important complication of lumbar disc surgery . Epidural fibrosis is one of the major causes of FBSS . However , most patients with epidural fibrosis do not develop symptomatic complaints from scarring . The purpose of this prospect i ve study was to evaluate the relationships among the severity of epidural fibrosis , psychological factors , back pain and disability after lumbar disc surgery . Twenty-nine surgically managed patients ( 13 women , 16 men ) were included in this study . In all patients , the presence and severity of epidural fibrosis was determined with contrast-enhanced magnetic resonance imaging ( MRI ) . A pain visual analog scale ( VAS ) and Oswestry Disability Question naire ( ODQ ) were completed before and after surgery . Subjects were grouped by their type of herniation ( protrusion , free fragment ) , MRI findings and results of the mini form of the Minnesota Multiphasic Personality Inventory ( MMPI ) , and the groups were compared for their VAS and ODQ scores . Our results disclosed that neither the postoperative VAS scores nor the postoperative ODQ scores differed significantly among the epidural fibrosis severity groups . Moreover , postoperative VAS scores were positively correlated with the scores of the mini MMPI . These findings indicate that epidural fibrosis may be considered as a radiological entity independent of patients ’ complaints . Furthermore , the mini MMPI should be included in the assessment and planning of the reoperations in FBSS patients , because of the importance of psychological factors in postoperative pain and disability BACKGROUND AND PURPOSE Spinal and muscle flexibility have been studied intensively and used clinical ly as outcome measurements in the rehabilitation of subjects with low back pain . The results of previous studies are contradictory and there is a lack of longitudinal data on the effects of long term therapeutic exercise on flexibility . METHOD A controlled experimental study was conducted to determine the effects of progressive therapeutic exercise on spinal and muscle flexibility . Eighty-six chronic low back pain subjects fulfilled the inclusion criteria and were divided into three study groups : ( 1 ) intensive training group , ( 2 ) home exercise group and ( 3 ) control group . The intervention period lasted three months and measurements were performed at both the beginning of the study and immediately after intervention . Follow-up measurements were carried out six and 12 months after baseline . Spinal flexibility was measured with lumbar flexion , extension , spinal lateral flexion and rotation , and muscle flexibility was measured with measurements of erector spinae , hamstring and iliopsoas muscles . Also self-reported outcomes of the Oswestry Index and Borg Scale -- Back Pain Intensity were used . Associations between change ( pre- to post-treatment ) were determined for the dependent variables . RESULTS The results showed no correlation between flexibility , the Oswestry Index or back pain intensity . After the first three-month period lumbar flexion , extension and spinal rotation decreased among all subjects . Spinal rotation and erector spinae muscle flexibility improved significantly with intensive training . At the nine-month follow-up , erector spine flexibility was still greater than at baseline . Hamstring flexibility increased among the intensive training and home exercise groups from pre- to post-intervention . However , the degree of hamstring flexibility gained during training was subsequently lost following the period without programmed exercise in both training groups . Self-reported outcome variables showed positive changes among the three study groups after the completion of intervention period , but these changes were only able to be maintained during subsequent follow-ups for the intensive training and home exercise groups . CONCLUSIONS The findings suggest that flexibility does not play an important role in coping with chronic low back pain for subjects whose functional limitations are not severe . Also , it appears that the achieved gains in spinal and muscle flexibility may not be able to be maintained without continued exercise OBJECTIVE To undertake a comparative examination of the reliability and validity of two frequently used self-report measures of functional disability , the Pain Disability Index  ( PDI ) and the Oswestry Low Back Pain Disability Question naire  ( OLBPDQ ) . DESIGN A descriptive ex-post facto design was used in the study . SETTING Pain clinics and neurosurgical units at three metropolitan hospitals . SUBJECTS One hundred patients with chronic low back pain of noncancer origin were administered the two question naires as part of a larger question naire battery . RESULTS Acceptable internal consistency values of 0.76 for the PDI and 0.71 for the OLBPDQ were obtained . A correlation of r = 0.63 was found between the PDI and the OLBPDQ , supporting the concurrent validity of the two scales . Both the scales were found to be correlated to the Beck Depression Inventory scores ( PDI , r = 0.42 ; OLBPDQ , r = 0.39 ) , with higher disability associated with greater depression . Only the total PDI score was found to be sensitive to functional status differences within the patient sample . CONCLUSIONS These findings support other recent work in favor of the PDI . The PDI had a slightly higher internal consistency and was more sensitive than the OLBPDQ Study Design . The Shuttle Walking Test ( SWT ) , the Swiss Spinal Stenosis ( SSS ) Question naire , the Oxford Claudication Score ( OCS ) , and the Oswestry Disability Index ( ODI ) were administered to patients with lumbar spinal stenosis and neurogenic claudication . Objective . To determine reliability of the SWT , the SSS ( Q1–12 ) , the OCS , and the ODI in lumbar spinal stenosis assessment . Summary of Background Data . Reliability data for exercise tests in lumbar spinal stenosis are lacking . Methods . To determine reliability , 32 clinic patients with lumbar spinal stenosis were assessed twice , with 1 week between assessment s. Retrospective data from 17 patients assessed before surgery and 18 months after surgery for lumbar spinal stenosis were used to investigate the use of reliability in a clinical setting . Results . Test – retest reliability in terms of the intraclass correlation coefficient ( ICC ) was 0.92 for the SWT , 0.92 for the SSS , 0.83 for the OCS and 0.89 for the ODI . The mean percentage scores were 51 for the SSS , 45 for the OCS , and 40 for the ODI . To achieve 95 % certainty of change between assessment s for a single patient , the SSS would need to change by 15 , the OCS by 20 , and the ODI by 16 . The mean SWT was 150 m , with a change of 76 m required for 95 % confidence . Cronbach ’s alpha was 0.91 for the SSS , 0.90 for the OCS , and 0.89 for the ODI . The change in ODI correlated most strongly with patient satisfaction after surgery ( & rgr ; = 0.80;P < 0.001 ) . Conclusions . Fluctuations in a patient ’s symptoms result in wide individual confidence intervals . Performance on the SSS , OCS , and ODI question naires are broadly similar , the most precise being the condition-specific SSS . The SWT gives a snapshot of physical function , which is acceptable for group analysis . Use of the SWT for individual assessment after surgery is feasible A longitudinal , prospect i ve study was conducted on 3,020 aircraft employees to identify risk factors for reporting acute back pain at work . The premorbid data included individual physical , psychosocial , and workplace factors . During slightly more than 4 years of follow-up , 279 subjects reported back problems . Other than a history of current or recent back problems , the factors found to be most predictive of subsequent reports in a multivariate model were work perceptions and certain psychosocial responses identified on the Minnesota Multiphasic Personality Inventory ( MMPI ) . Subjects who stated that they “ hardly ever ” enjoyed their job tasks were 2.5 times more likely to report a back injury ( P = 0.0001 ) than subjects who “ almost always ” enjoyed their job tasks . The quintile of subjects scoring highest on Scale-3 ( Hy ) of the MMPI were 2.0 times more likely to report a back injury ( P = 0.0001 ) than subjects with the lowest scores . The multivariate model , including job task enjoyment , MMPI Scale-3 , and history of back treatment , revealed that subjects in the highest risk group had 3.3 times the number of reports in the lowest risk group . These findings emphasize the importance of adopting a broader approach to the multifaceted problem of back complaints in industry and help explain why past prevention efforts focusing on purely physical factors have been unsuccessful OBJECTIVE Develop and test a short-form comprehensive outcome measure for back pain . DESIGN Prospect i ve longitudinal study of 3 consecutive cohorts of back pain patients . SETTING Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practice s. METHOD Domains judged important in the back pain model and responsive to clinical change were identified from the literature . Items were scored on an 11-point numerical rating scale . The instrument was psychometrically tested by use of those tests relevant to an evaluative measure . RESULTS Seven dimensions of the back pain model were included in the question naire . Having established face validity , the instrument was shown to demonstrate high internal consistency ( Cronbach 's alpha = 0.9 ) and good test-retest reliability ( ICC = 0.95 ) . All items were retained on the basis that they contributed to the overall score ( item-corrected total score correlations ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations ) . The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures . The effect size of the instrument was high ( 1.29 ) and comparable with established measures . CONCLUSION A reliable , valid , and responsive instrument has been developed for use in back pain patients . It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments Study Design A prospect i ve cohort study of patients in Maine with sciatica and lumbar spinal stenosis treated surgically and nonsurgically .  Summary of Background Data In 1987 , the Quebec Task Force on Spinal Disorders proposed a diagnostic classification to help make clinical decisions , evaluate quality of care , assess prognosis , and conduct research . Objectives To assess the Quebec Task Force classification 's ability to stratify patients according to severity and treatment at baseline , and to assess changes over time in health‐related quality of life , including symptoms , functional status , and disability . Methods Five hundred sixteen patients participating in the Maine Lumbar Spine Study who completed baseline and 1‐year follow‐up evaluations were classified successfully according to the Quebec Task Force classification . Patient characteristics and treatments were compared across Quebec Task Force classification categories . Changes in health‐related quality of life over 1 year were assessed according to Quebec Task Force classification category and type of treatment . Results Among patients with sciatica ( n = 370 ) , higher Quebec Task Force classification categories ( from 2 , pain radiating to the proximal extremity , to 6 , sciatica with evidence of nerve root compression ) were associated with increased severity of symptoms at baseline . There was no association between Quebec Task Force classification and baseline functional status . Quebec Task Force classification was associated strongly with the likelihood of receiving surgical treatment ( P ≤ 0.005 ) . Among patients with sciatica treated nonsurgically , improvement at 1 year in back‐specific and generic physical function increased with higher Quebec Task Force classification category ( P ≤ 0.05 ) . Only a nonsignificant trend was observed for surgically treated patients . Patients with lumbar spinal stenosis ( Quebec Task Force classification 7 , n = 131 ) had baseline features and outcomes distinct from patients with sciatica . Conclusions For patients with sciatica , the Quebec Task Force classification was highly associated with the severity of symptoms and the probability of subsequent surgical treatment . Nonsurgically treated patients in Quebec Task Force classification categories reflecting nerve root compression had greater improvement than those with pain symptoms alone . Among surgical patients , the Quebec Task Force classification was not associated with outcome . These results provide validation for the classification and its wider adoption . Nonetheless , improved diagnostic classifications are needed to predict outcomes better in patients with sciatica who undergo surgery A total of 113 patients , excluding those with tumor , spondylitis , and idiopathic scoliosis , underwent anterior lumbar interbody fusion ( ALIF ) with autologous iliac crest graft between 1984 and 1991 at our department . The proportion of these who were failed back patients was higher than that reported in the literature . Evaluation of functional outcome was feasible in 80 patients , utilizing Oswestry and Marburg scores , which were closely intercorrelated . The overall results yielded an improvement in the Oswestry score of 35.7 percentage points . A subset of 52 patients who were evaluated twice , showed the same results at an average of 6.6 years as they did at 2.3 years following surgery . Functional results showed a weak correlation with postoperative height loss of the intervertebral space . Influencing factors for the functional result were : postoperative compensation cl aim , age , and obesity . Of the professional people involved , 19.4 % did not return to any occupation . Patients satisfied with the result had significantly greater functional improvement . Younger patients with additional dorsal distraction prior to ALIF for reduction of severe spondylolisthesis fared better than patients with ALIF alone . The rate of complications was low and did not contribute to the postoperative functional result . On the basis of these results further prospect i ve studies have been design ed and are currently underway Study Design . A comparative evaluation of outcome instruments and global assessment was performed . Objective . To test patient global assessment as a substitute for the use of more comprehensive outcome instruments in treatment trials of chronic low back pain . Summary of Background Data . Treatment outcome can be measured with pain scales and functional instruments . In the absence of a gold st and ard , the patient him- or herself is the basic reference for outcome , for which the instruments give a more or less exact measurement . Global assessment , which is a retrospective recording , may overestimate improvement as a result of recall or motivational bias . Methods . In this study , 294 patients treated for chronic low back pain were evaluated with a  visual analog scale for back pain , the  Oswestry  Disability Index , the Million Score and general function score for disease-specific disability , and the Zung Depression Scale for depressive symptoms .  The correlation between the pretreatment and posttreatment scores for the outcome instruments ( & Dgr ; scores ) and the global assessment scores was calculated ; effect sizes were compared ; sensitivity and specificity with receiver operating characteristics ( ROC ) curves were estimated ; and associations of global assessment with pretreatment and posttreatment scores were determined . Results . All the & Dgr ; scores showed significant correlations with patient global assessment and with each other . The effect size of global assessment tended to be greater than that of the outcome instruments . The specificity and sensitivity of the disability instruments and pain scale were approximately 75 % , whereas they were lower for depression . The associations between global assessment and outcome instrument scores did not produce evidence that global assessment was biased . Conclusion . Patient global assessment is a valid and responsive descriptor of overall effect in r and omized controlled trials of treatment for chronic low back pain Study Design . A cross-cultural adaptation and cross-sectional study of a sample of lumbar spine patients , with a sub sample followed prospect ively for retest reliability . Objectives . To assess the Italian version instrument reliability and validity . Summary of Background Data . The orthopaedic outcome measurements have been usually focused on objective parameters as radiograph measures or other technical aspects . However , these parameters are weakly related with outcomes that are more relevant to patients as functional status and symptoms . In the last ten years , the patient-oriented measures have become an important aspect of spinal clinical outcome evaluation . The most common instruments to assess patient perspective are self-administered question naires that must be vali date d by a widely accepted process to evaluate reliability and validity , which are fundamental for every instrumental measure . Methods . The North American Spine Society ( NASS ) question naire was culturally adapted for Italian-speaking people following the Guillemin criteria . The Italian version was tested on 74 consecutive patients who were referred to the authors ’ department and suffered from low back pain with leg irradiation . The results were compared with other vali date d patient-oriented measures . Forty-eight-hour retests were performed on a sub sample of 45 patients . Results . The question naire was favorably accepted by patients . The lumbar spine pain and disability and neurogenic symptoms subscales showed a high correlation with other patient-oriented measures , as hypothesized , and it also showed good values on test-retest . Conclusions . The question naire should be considered for patient health status monitoring and for clinical trials Study Design . A prospect i ve cohort design was used to evaluate the Functional Rating Index in a multicentered setting with 139 participants . The Functional Rating Index is a self-reporting instrument consisting of 10 items , each with 5 possible responses that express graduating degrees of disability . Objectives . The goal of this study was to evaluate the psychometric qualities of the Functional Rating Index . Summary of Background Data . The Functional Rating Index combines the concepts of the Oswestry Low Back Disability Question naire and the Neck Disability Index and seeks to improve on clinical utility ( time required for administration ) . Methods . One hundred thirty-nine subjects with spinal complaints participated in four different cohorts to study reliability , validity , responsiveness , and clinical utility . Results . Reliability : Test-retest : Intraclass correlation coefficient was excellent ( ICC3,k = 0.99 ) ; interitem correlation : Item efficiency was good , ranging between 0.54 and 0.82 , with a moderate correlation among all items ; Cronbach ’s alpha was excellent ( 0.92 ) . Validity : construct : The Functional Rating Index correlated with the Disability Rating Index ( 0.76 ) , the Short Form-12 Physical Component Score ( 0.76 ) , and the Short Form-12 Mental Component Score ( 0.36 ) . Responsiveness : Overall , the size effect was 1.24 , which is commendable . Clinical utility : Time required by the patient and staff averaged 78 seconds per administration , which is noteworthy . Effect of Sociodemographics : Total scores were not affected by education , gender , nor age , suggesting minimal external validity bias . Conclusions . The Functional Rating Index appears to be psychometrically sound with regard to reliability , validity , and responsiveness and is clearly superior to other instruments with regard to clinical utility . The Functional Rating Index is a promising useful instrument in the assessment of spinal conditions Study Design . A prospect i ve consecutive cohort study of patients with cervical spine pain and patients with lumbar spine pain referred to an academic medical center . Objectives . To investigate the presence of fear-avoidance beliefs in a sample of patients with cervical spine pain and to compare the association of pain intensity , disability , and fear-avoidance beliefs in patients with cervical spine pain with that in patients with lumbar spine pain . Summary of Background Data . Fear-avoidance beliefs are a specific psychosocial variable involved in the development of disability from low back pain . Psychosocial variables are believed to play a role in cervical disability , but specific variables have not been investigated . Methods . Consecutive patients referred to a multidisciplinary center completed self-reports of  disability , pain intensity , and fear-avoidance beliefs during an initial evaluation session . Gender , type of symptom onset , acuity , and payer source were also recorded . Associations between disability , pain intensity , and fear-avoidance beliefs were investigated in patients with cervical spine pain and patients with lumbar spine pain . Results . In all , 163 patients completed the self-reports and were included in this study . Weaker relations between fear-avoidance beliefs and disability were found in patients with cervical pain than in those with lumbar pain . Significant differences in fear-avoidance beliefs were found for gender , type of symptom onset , and payer source ( workers ’ compensation , auto insurance , and traditional insurance ) . Conclusion . The associations among fear-avoidance beliefs , pain intensity , and disability differed between patients with cervical spine pain and patients with lumbar spine pain .  Fear-avoidance beliefs were significantly different in subgroups of patients Abstract The General Function Score ( GFS ) is a disease-specific instrument consisting of nine items focusing on strict physical activities of daily living . It is intended as an alternative to the more complex scores of disability ( such as the Oswestry Disability Index ) , serving as a complement to the quality of life instruments in the study of low back pain ( LBP ) . It was developed from an original 17-item question naire , of which 11 of the items were tested for criterion validity in an observer-supervised performance test . Two items were excluded from further analysis because of too low a validity . The remaining nine-item GFS was tested for construct validity , reliability , feasibility and responsiveness in six different cohorts : 297 patients with chronic low back pain ( cohort 1 ) , an age- and sex-matched control group of 287 r and omly allocated Swedish citizens ( cohort 2 ) , three separate groups of patients admitted for surgery due to low back disorders ( cohorts 3–5 ) and out patients with spinal disorders ( cohort 6 ) . Correlations were tested with the Spearman Rank correlation coefficient , differences between groups with the Mann-Whitney test and the internal consistency with the Cronbach 's coefficient α . The GFS total scores showed correlations of 0.78 , 0.81 and 0.88 in the three aspects of the performance test . The response rate was 98.3–100 % . The mean time to complete the question naire was 1.2 min . The internal consistency was 0.69 and 0.86 in cohorts 1 and 2 respectively . The test-retest correlation was 0.88 . The GFS showed a high responsiveness to difference and change . The effect size was 0.82–0.96 in surgically treated disc herniation and 0.55–0.85 in spondylolisthesis . The GFS is a highly valid and reliable instrument with good responsiveness and feasibility , useful for evaluation of physical disability STUDY DESIGN A 2-year prospect i ve inception cohort study of back injury in nurses . OBJECTIVES To determine the extent to which characteristics of nurses , of the injury , and of the workplace predict occurrence and duration of time loss from work after back injury . SUMMARY OF BACKGROUND DATA During 2 years , 320 nurses incurred 416 back injuries at a large teaching hospital in Winnipeg , Canada . Nurses injured on preselected wards were targeted for early intervention , including provision of modified work , whereas nurses injured on other wards received the usual care . METHODS Time loss attributable to the back injury during the 6 months after injury was analyzed . Three statistical models were used to examine occurrence of time loss ( logistic regression ) , duration of time loss ( Tobit regression ) , and duration of time loss once an injury incurring time loss had been documented ( least-squares regression ) . RESULTS In 218 of the 416 injuries , the injured nurse consented to interview . Whereas perceived disability was related to whether a time loss injury would ensue , self-reported pain was strongly related to the duration of time loss once an injury had become a time loss injury . Duration of time loss was reduced by participation in the return-to-work program . Mechanism of injury , specifically injury occurring while lifting patients , result ed in greater time loss . CONCLUSIONS Focusing on reducing the perception of disability at the time of injury is critical to preventing time loss , but once time loss has occurred , offer of modified work and attention to pain reduction are warranted . The findings add to the evidence that workplace-based intervention programs can be effective in reducing the morbidity result ing from back injury & NA ; This study compares the responsiveness of three instruments of functional status : two disease‐specific question naires ( Oswestry and Rol and Disability Question naires ) , and a patient‐specific method ( severity of the main complaint ) . We compared changes over time of functional status instruments with pain rated on a visual analog scale . Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used : effect size statistics and receiver‐operating characteristic method . We chose global perceived effect as external criterion . A cohort of 81 patients with non‐specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment . According to the external criterion 38 patients improved . The results of both strategies were the same . All instruments were able to discriminate between improvement and non‐improvement . The effect size statistics of the instruments were higher in the improved group than in the non‐improved group . For each instrument the receiver‐operating characteristic curves showed some discriminative ability . The curves for the Rol and Question naire and pain were closer to the upper left than the curves for the other instruments . The sensitivity to change of the rating of Oswestry Question naire was lower than that of the other instruments . The main complaint was not very specific to change . The two strategies for evaluating the responsiveness were very useful and appeared to complement each other The present study focuses on the long-term prognosis of radiographically verified stenosis of the lower lumbar spine . The purpose here was to describe the outcome 12 years after radiographic diagnosis of spinal stenosis and to identify factors predicting disability after operative or conservative treatment . Data were compiled on 75 patients ( 43 men and 32 women ) with changes in functional myelography diagnostic for spinal stenosis . Their mean age at the interview 12 years later was 61 years .  The sagittal diameter of the dural sac was measured from baseline myelographs at all intervertebral levels and was corrected for magnification . In the interview , subjective outcome assessment was obtained with a structured question naire , and the low-back disorder was scored using the Oswestry disability index . The sagittal diameter of the dural sac was severely stenotic ( < 7.0 mm ) in 32 patients ( 26 operated ) , and moderately stenotic ( 7.0 - 10.5 mm ) in 43 patients ( 31 operated ) . The severity of the stenosis significantly predicted disability , even when the effects of age , sex , therapy regimen , and body mass index were adjusted for . For moderate and severe stenosis , the adjusted mean Oswestry indices were 28.4 and 39.1 , respectively ( p = 0.01 ) . Therapy as such ( operative versus nonoperative ) did not significantly correlate with later disability . The radiographic severity of lumbar spinal stenosis predicts disability independently of therapy regimen . R and omized clinical trials are needed to establish the indications for surgical and conservative treatment . Radiographic severity of the stenosis should be considered as an effect-modifying or confounding factor in clinical trials and other studies focusing on the outcome of lumbar spinal stenosis The Low-Back Outcome Score has been devised as a new and accurate rating system for patients with low-back pain . Thirteen factors , such as pain , employment , sporting ability , rest required , and activities of daily living , were included ; subjective opinion was excluded . Pain and active pursuits were weighted . Presentation of the score as a question naire , excluding examination findings , eliminated both interobserver variation and observer variation with time . The score was applied retrospectively in a follow-up study of conservatively treated patients and was found to be more comprehensive and more discriminating than the Oswestry Disability Score , the Waddell Disability Rating , or the Waddell Physical impairment Rating . The  Low-Back Outcome Score  is recommended for further evaluation in future prospect i ve studies in low-back pain STUDY DESIGN A prospect i ve observational study on the use of the Aberdeen Low Back Pain Disability Scale . OBJECTIVE To evaluate the reliability , validity , and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain . SUMMARY OF BACKGROUND DATA Frontline clinicians , research ers , and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing . METHODS Four sample s with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale  were observed and measured at time points including the beginning physiotherapy ; 10 days , 3 weeks , and 6 weeks after physiotherapy ; and when discharged from treatment . RESULTS The test-retest reliability coefficient was 0.94 ( 0.94 in the original English version ; figures from the English version are reported in parentheses ) . The Cronbach alpha coefficient was 0.85 ( 0.80 ) . The Spearman correlation coefficient , when the Aberdeen score was correlated with that of a generic current 42-item question naire regarding the patient 's perceived health to establish cross-sectional construct validity , was 0.59 ( 0.36 - 0.66 , with the Short Form 36 scale ) . The effect sizes ( responsiveness ) at weeks 3 and 6 after treatment began were 0.59 and 0.81 , respectively ( a high of 0.62 reported in the English version ) . CONCLUSIONS The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability , validity , and responsiveness of the original English version when tested in Hong Kong in four sample s of Chinese patients with low back pain Low Back Pain Rating scale is an index scale which includes measurements of pain intensity , disability , and physical impairment . The scale was design ed to monitor the outcome of clinical trials of low back pain treatment . It has been vali date d in 58 patients following first-time discectomy .  The scale rating can be rapidly carried out and requires no special aids . With slight modification it can be used in office and telephone interviews , as well as postal question naires . These modifications only slightly reduce the quantity of information gathered . In the study , a high rater agreement ( 97.7 % ) was found without level difference between two observers using the scale . The validation process included : construct validity , criterion-related validity and item bias , relative to Global Assessment s pronounced by the patient and an experienced clinician . Low Back Pain Rating scale hs been shown to be valid and reliable in the assessment of low back pain Abstract A new measure is presented , suitable for documenting severity and response to treatment in chronic low‐back pain syndromes . It is self‐administered and combines two pain and seven mobility items . These were selected from pre‐existing vali date d instruments on the basis of their sensitivity to change after treatment . Their Italian vali date d translation was adopted . The measure was administered to 32 chronic low‐back pain Italian patients , all refractory to previous conservative treatments . In most cases they presented with herniation or protrusion of 1–3 lumbar discs . Patients were treated with 3–6 sessions of autotraction over a 5‐ to 15‐day period . Scores on the scale were recorded at admission , discharge and follow‐up , 1–3 months after treatment . At discharge and at follow‐up , patients were asked if , overall , they felt improved , the same or worse . At follow‐up , 20 patients out of 32 reported overall improvement . Scalometric properties of the measure were tested using Rasch analysis . For admission and follow‐up , items followed a consistent hierarchical relationship along a unidimensional pain/disability variable , which is being called back illness . The items were not redundant , in that they spread well along a wide range of difficulty/severity . The hierarchy matched well with the expected expression of the conditions of the patients . A study was conducted on 34 chronic back pain patients , showing satisfactory test‐retest reliability . Depending on the various items , Cohen 's unweighted K ranged from 0.27 to 0.78 , with ten of the 11 items above the 0.45 level of acceptability , while intraclass correlation coefficients ranged from 0.42 to 0.89 . At follow‐up , changes in BACKILL of plus 15 % or more , with respect to admission , were consistent with patients ' reports of improvement in 19 out of 20 cases . Changes in BACKILL of less than 15 % were consistent with patients reports of being the same or worse in 11 out of 12 cases STUDY DESIGN A cross-sectional clinical study . OBJECTIVES To determine whether there are specific symptoms , signs , and functional disability associated with adult spondylolisthesis . SUMMARY OF BACKGROUND DATA In spite of the common occurrence of adult spondylolisthesis , the symptoms , signs , and disability associated with it have not been analyzed in a large , well-defined group of patients . METHODS The symptoms , signs , and disability of 111 consecutive patients with adult spondylolisthesis , before r and omized treatment with fusion or physiotherapy  , were compared with those of 39 patients with nonspecific low back pain before lumbar fusion .  The patients completed a question naire covering clinical history and symptoms and su bmi tted a pain drawing . The signs were documented . Functional disability and pain were quantified by 12-function and 2-pain visual analog scales , respectively . RESULTS Sixty-two percent of the patients reported low back pain as well as sciatica , 7 % sciatica only , and 31 % low back pain only . Specific signs were infrequent . A positive straight leg raising test result in 12 % and an L5 sensory disturbance in 13 % were the most common . The symptoms were similar in patients with spondylolisthesis and chronic low back pain , but the chronic low back pain group reported more functional disability . Patients with a nonorganic pain drawing ( widespread , nonspecific pain ) were more often blue collar workers ; were more often and longer on sick leave ; and reported reduced mental condition , sexual function , functional ability , and more pain than patients with an organic pain drawing ( localized , specific pain ) . CONCLUSIONS The clinical pattern and functional disability in adult spondylolisthesis and in low back pain of nonspecific origin are similar . Sciatica in adult spondylolisthesis is typically not associated with a positive straight leg raising test result Study Design . A prospect i ve test-retest study was conducted to investigate both new and follow-up patients with low back pain presenting to an orthopedic surgeon specializing in back pain . Objectives . To further vali date the internal consistency and test – retest reliability of the Low Back Outcome Score , and to compare these results with other condition-specific disability scales . Summary of Background Data . To be useful in clinical practice , health-specific question naires must demonstrate reliability and validity . Several disease-specific question naires for low back pain have been vali date d to different extents . Methods . In this study , 102 new and 42 follow-up patients consecutively attending a consultant clinic completed the Low Back Outcome Score on their visit  , then again after an interval of 1 week in postal form . This instrument also was completed by 230 patients presenting to a physiotherapist . Results . A response rate of 90 % was achieved for the postal question naire . A test of internal consistency conducted with the study sample achieved a Cronbach alpha coefficient of 0.85 . Overall agreement for test – retest reliability was 84 % , and the reliability coefficient ( K ) reached a range of 0.51 to 0.86 ( P < 0.05 ) . A Bl and /Altman plot was calculated , demonstrating that only 5 % of patient scores change by more than 11.6 scale points between test and retest , which is not sufficient to change outcome categories . Conclusion . The Low Back Outcome Score appears to have good internal consistency and test – retest reliability for use in clinical practice Abstract Objective : To compare the effectiveness over three years of chiropractic and hospital outpatient management for  low back pain .  Design : R and omised allocation of patients to chiropractic or hospital outpatient management . Setting : Chiropractic clinics and hospital outpatient departments within reasonable travelling distance of each other in 11 centres . Subjects : 741 men and women aged 18 - 64 years with low back pain in whom manipulation was not contraindicated . Outcome measures : Change in total Oswestry question naire score and in score for pain and patient satisfaction with allocated treatment . Results : According to total Oswestry scores improvement in all patients at three years was about 29 % more in those treated by chiropractors than in those treated by the hospitals . The beneficial effect of chiropractic on pain was particularly clear . Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment . Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management . Conclusions : At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals Quality of life has been defined as “ the extent to which our hopes and ambitions are matched by experience . ” To improve a patient 's quality of life through medical care would be to “ narrow the gap between a patient 's hopes and expectations and what actually happens . ” Using the above definition as a conceptual basis , we produced a self-administered , Patient-Generated Index ( PGI ) of quality of life .  The PGI was completed by 359 patients presenting with low back pain . The validity of the measure was assessed by correlating patients ' PGI scores with a well-vali date d health profile , the Short-Form 36-item Health Survey ( SF-36 ) , and with their scores on a clinical back pain question naire . Stepwise multiple regression was then used to model the relationship between the PGI score and the SF-36 . Patients ' PGI scores showed a high correlation with SF-36 scales measuring pain , social functioning , and role limitations attributable to physical problems , and with the clinical question naire . Together with whether a person was retired or not , these health variables were able to explain 25 % of the variance in PGI scores . Patient generated index scores were significantly lower in patients referred to hospital compared with those managed solely in general practice and tended to reflect the general practitioner 's assessment of symptom severity . We conclude that it is possible to construct a question naire that quantifies the effect of a medical condition on patients ' quality of life in a way that has meaning and relevance in the context of their daily lives . The PGI has considerable potential for routine use in a wide range of clinical conditions for which the measurement of outcome has hitherto proved very difficult STUDY DESIGN A prospect i ve , consecutive study of patients ' outcome  at three subsequent follow-up times after lumbar disc surgery .  OBJECTIVES To evaluate how consistent outcome remained in a group of patients after lumbar disc surgery .  SUMMARY OF BACKGROUND DATA Despite similar results concerning the overall outcome , results in most studies show different prognostic factors for lumbar disc surgery at different follow-up times . A reason for this observation could be that patients shift to a different outcome group during the observation period . METHODS Before surgery and at the three follow-ups ( 3 , 12 , and 28 months after surgery ) the Low Back Outcome Score was calculated . Groups with favorable and unfavorable outcome were determined after each follow-up according to the scores . RESULTS Ninety-eight patients were studied . Forty percent showed an unstable outcome at different follow-up times . For each follow-up , three prognostic factors were determined . No prognostic factor showed significance at all follow-up examinations . CONCLUSIONS Patients whose outcome after lumbar disc surgery does not remain stable present a major problem in the calculation of prognostic factors Study Design A prospect i ve cohort study of patients seen in primary care for low back pain . Objectives A new measure of back pain outcomes is used to describe the status of back problems at various intervals after visits to primary care physicians and to identify subsets of patients with worse prognoses . Summary of Background Data Most previous studies of the prognosis of back pain in primary care have failed to provide clinical ly useful information . Methods Baseline data were collected from 219 patients making an initial visit for an episode of low back pain to a primary care clinic . A measure of how patients reported they would feel if they had their current back symptoms for the rest of their lives ( “ Symptoms Satisfaction ” ) was used to distinguish good from poor outcomes . Patient outcomes were assessed 1 , 3 , 7 , and 52 weeks after the index visit . Results Only 67 % of patients reported good outcomes after 7 weeks , and only 71 % were satisfied with their condition 1 year later . After controlling for the effects of other variables measured during the initial physician visit , only younger age , depression , and pain below the knee were significant predictors of poor outcome at 7 weeks , and only pain below the knee and depression were significant predictors at 1 year . Conclusions The proportion of primary care patients with back pain who have poor outcomes appears to be higher than generally recognized . Ways of improving how primary care responds to patients with persisting pain should be investigated Study Design . A r and omized controlled trial comparing usual care with a program for the coordination of primary health care ( CORE ) for the treatment of subacute low-back pain patients . Objectives . To measure the effectiveness of the CORE program  as a mean for implementing clinical practice guidelines for low-back pain in an urban community . Summary of Background Data . Clinical practice guidelines have been developed for primary care physicians and patients on the clinical management of low-back pain . The implementation of the guidelines in a large community is difficult with the multiplicity of medical and nonmedical back care providers and products . The CORE program was design ed to make the guidelines fit in this complex environment . Methods . One hundred ten workers compensated for low-back pain for 4 to 8 weeks in metropolitan Montreal were r and omized in two groups : usual care ( N=56 ) and the CORE program ( N=54 ) . Coordination of primary health care was performed by two primary care physicians and a nurse in liaison with the treating physicians , and included a complete examination , recommendations for the clinical management , and support to carry out the recommendations . All workers were followed for 6 months . Back pain and functional status were assessed at baseline , 3 months , and 6 months . Results . In the 6-month follow-up , the CORE group returned to work 6.6 days ( st and ard error = 8.9 ) quicker than the control group , a difference that was not statistically significant . However , the CORE group showed a sustained improvement in pain and functional status with two-fold differences at the end of the 6 months of follow-up . This represented nine points on the Oswestry scale ( P = 0.02 ) and 12 points on the Quebec Back Pain Disability Scale ( P = 0.01 ) . The CORE group also used three times less specialized imaging tests of the spine at 3 months ( P < 0.01 ) and exercised twice as much at 6 months ( P < 0.05 ) than the controls . Conclusions . The therapeutic results for workers with low-back pain could be improved by implementing the clinical practice guidelines with primary care physicians in a large community , without delaying the return to work . The CORE intervention for back pain patients ishighly relevant to primary care practice . It is simple in its application , flexible to accommo date physicians ’ and patients ’ preferences in health care , and it is effective on patients ’ clinical outcome There is growing evidence for the idea that in back pain patients , pain-related fear ( fear of pain/physical activity/(re)injury ) may be more disabling than pain itself . A number of question naires have been developed to quantify pain-related fears , including the Fear-Avoidance Beliefs Question naire ( FABQ ) , the Tampa Scale for Kinesiophobia ( TSK ) , and the Pain Anxiety Symptoms Scale ( PASS ) . A total of 104 patients , presenting to a rehabilitation center or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aim ed at ( 1 ) replicating that pain-related fear is more disabling than pain itself ( 2 ) investigating the association between pain-related fear and poor behavioral performance and ( 3 ) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs ( e.g. pain catastrophizing ) . All three studies showed similar results . Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance . Even when controlling for sociodemographics , multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance . The PASS appeared more strongly associated with pain catastrophizing and negative affect , and was less predictive of pain disability and behavioral performance . Implication s for chronic back pain assessment , prevention and treatment are discussed To identify predictors of back-related long-term functional limitations , 1213 adult enrollees of a Health Maintenance Organization ( HMO ) in Washington state were interviewed about a month after a consultation for back pain in a primary care setting in 1989 - 1990 , and followed each year thereafter . Out of 100 factors documented at the one-month assessment , measures of somatization , depression , functional limitations , and pain were the strongest predictors of two-year modified Rol and -Morris score among a r and om sub sample of 569 subjects . A multiple regression model containing the Symptom Checklist Depression and Somatization scores , the one-month modified Rol and -Morris score and the number of pain days in the past six months explained about 30 % of the variance in the outcome . Using recursive partitioning , a very simple model was developed to identify patients at high risk of sustaining long-term significant functional limitations . The regression model and the recursive partitioning model were successfully tested in a fresh sample of patients ( n = 644 ) . Clinical application of the recursive partitioning model and method ological aspects of this study are discussed A prospect i ve study was set up to evaluate the influence of psychological distress on the outcome of lumbosacral fusion in a group of chronic low back pain ( CLBP ) patients . Response to low back surgical procedures depends upon physical and psychological factors . Various reports exist concerning the influence of a patient 's psychological condition on the outcome of low back surgery . Few investigators , however , have checked this influence in a prospect i ve manner . A psychogenic back pain score ( NPL ) was administered to 53 CLBP patients ( 24 men and 29 women ) prior to surgery , to evaluate the presence of psychological distress . According to the test score patients were divided in an " organic " , an " uncertain " and a " psychogenic " group . Disability in activities of daily living result ing from the back pain was also scored preoperatively with the Oswestry Disability Index ( ODI ) . Twelve months after surgery the ODI was readministered to the 50 patients available to follow-up . Each group separately showed significant improvement of disability 12 months after fusion , however , the " organic " group scored significantly better than the " psychogenic " group . Question naires about back pain , sciatic pain and use of analgesics and Visual Analog Scales regarding pain and disability also indicated better results in the " organic " group . Psychological distress deteriorates the subjective outcome of lumbosacral spine fusion and psychological screening should indeed be an integral part of the global assessment of CLBP patients , especially when surgery is considered
target: Most of the outcome question naires had a mixed content reflecting various constructs such as pain and symptoms , sleep disturbances , psychological dysfunctions , physical impairments , and social functions .
background: STUDY DESIGN A systematic literature review of outcome question naires design ed for assessing functional status or disability in patients with low back pain .
  OBJECTIVES To provide a comprehensive overview of all functioning/disability question naires used in recent years and to explore how the main concept(s ) was described or defined in the original paper , the content or the domains of disability , and the measurement properties of the question naires .
  SUMMARY OF BACKGROUND DATA A number of clinical tools design ed for evaluating the functional status of patients with low back pain have been developed .
  Only a few have been review ed earlier , and there has been little focus on the content reflected in the question naires .