Defining the minimum level of detectable change for the Roland-Morris questionnaire.

BACKGROUND AND PURPOSE The Roland-Morris Questionnaire (RMQ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale. The RMQ has been shown to yield reliable measurements, which are valid for inferring the level of disability, and to be sensitive to change over time for groups of patients with low back pain. Little is known about the usefulness of this instrument in aiding decision making regarding individual patients. The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients. SUBJECTS The study sample consisted of 60 outpatients with low back pain. METHODS The RMQ was administered at the subjects' initial visit and again 4 to 6 weeks later. Conditional standard errors of measurement (CSEMs) were computed for initial and follow-up RMQ scores, and these values were used to estimate the minimum level of detectable change. Results. Minimum levels of detectable change at the 90% confidence level varied from 4 to 5 RMQ points. CONCLUSION AND DISCUSSION The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale (4-20 RMQ points); however, the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20.

[1]  A. Garratt,et al.  A New Approach to the Measurement of Quality of Life: The Patient‐Generated Index , 1994, Medical care.

[2]  M. Roland,et al.  A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. , 1983, Spine.

[3]  M. Hupli,et al.  Intercorrelation and test-retest reliability of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. , 1993, The Clinical journal of pain.

[4]  I. Holme,et al.  The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. , 1993, Spine.

[5]  Adams Ah,et al.  Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial. , 1992 .

[6]  P. Stratford,et al.  A randomized controlled trial of transcutaneous electrical nerve stimulation (CODETRON) to determine its benefits in a rehabilitation program for acute occupational low back pain. , 1994, Spine.

[7]  K. Ottenbacher,et al.  The significance of clinical change and clinical change of significance: issues and methods. , 1988, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[8]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[9]  G. Guyatt,et al.  Measurement of health status. Ascertaining the minimal clinically important difference. , 1989, Controlled clinical trials.

[10]  M. Roland,et al.  A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. , 1983, Spine.

[11]  G H Guyatt,et al.  Determining a minimal important change in a disease-specific Quality of Life Questionnaire. , 1994, Journal of clinical epidemiology.

[12]  R A Deyo,et al.  Comparative Validity of the Sickness Impact Profile and Shorter Scales for Functional Assessment in Low-Back Pain , 1986, Spine.

[13]  P. Stratford,et al.  The Quebec Back Pain Disability Scale: measurement properties. , 1995, Spine.

[14]  R A Deyo,et al.  Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. , 1986, Journal of chronic diseases.

[15]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[16]  J C Fairbank,et al.  The Oswestry low back pain disability questionnaire. , 1980, Physiotherapy.

[17]  P. Stratford,et al.  Assessing change over time in patients with low back pain. , 1994, Physical therapy.

[18]  G. Waddell,et al.  Assessment of Severity in Low‐Back Disorders , 1984, Spine.

[19]  A. Garratt,et al.  Developing a Valid and Reliable Measure of Health Outcome for Patients With Low Back Pain , 1994, Spine.

[20]  L. S. Feldt,et al.  A Comparison of Five Methods for Estimating the Standard Error of Measurement at Specific Score Levels , 1985 .

[21]  J. Keats.  Estimation of error variances of test scores , 1957 .

[22]  W. Fordyce.  Outcome of two multimodal back treatment programs with and without intensive physical training. , 1994, Journal of spinal disorders.