A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

[1]  P. Stratford,et al.  Defining the minimum level of detectable change for the Roland-Morris questionnaire. , 1996, Physical therapy.

[2]  Mimicking properties of nonparametric rank tests using scores that are not ranks , 1993 .

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

[4]  P. Pynsent,et al.  The Oswestry Disability Index. , 2000, Spine.

[5]  J. Ware SF-36 health survey: Manual and interpretation guide , 2003 .

[6]  J A Kopec,et al.  Measuring functional outcomes in persons with back pain: a review of back-specific questionnaires. , 2000, Spine.

[7]  C. Maher,et al.  The role of functional status questionnaires for low back pain. , 1997, The Australian journal of physiotherapy.

[8]  J. D. Sullivan Back Pain in the Workplace: Management of Disability in Nonspecific Conditions , 1996 .

[9]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[10]  D L Riddle,et al.  Health status measures: strategies and analytic methods for assessing change scores. , 1996, Physical therapy.

[11]  R. Epstein,et al.  Interpretation of quality of life changes , 1993, Quality of Life Research.

[12]  M. Liang,et al.  Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. , 1995, Journal of clinical epidemiology.

[13]  D. Streiner,et al.  Health Measurement Scales: A practical guide to thier development and use , 1989 .

[14]  L. Bouter,et al.  On the course of low back pain in general practice: a one year follow up study , 1998, Annals of the rheumatic diseases.

[15]  S. Haslett,et al.  SF‐36 health survey reliability, validity and norms for New Zealand , 1999, Australian and New Zealand journal of public health.

[16]  Jacques P. Brown,et al.  Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[17]  M. Liang,et al.  Comparisons of Five Health Status Instruments for Orthopedic Evaluation , 1990, Medical care.

[18]  G. Guyatt,et al.  Measuring quality of life in children with asthma , 1996, Quality of Life Research.

[19]  A. Delitto,et al.  Are measures of function and disability important in low back care? , 1994, Physical therapy.

[20]  N. Aaronson,et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. , 1998, Journal of clinical epidemiology.

[21]  R. Hays,et al.  Responsiveness to change: an aspect of validity, not a separate dimension , 1992, Quality of Life Research.

[22]  L Abenhaim,et al.  The Quebec Back Pain Disability Scale: Measurement Properties , 1995, Spine.

[23]  H C de Vet,et al.  Measuring the Functional Status of Patients With Low Back Pain: Assessment of the Quality of Four Disease-Specific Questionnaires , 1995, Spine.

[24]  D. Singer,et al.  Assessing Health‐Related Quality of Life in Patients With Sciatica , 1995, Spine.

[25]  A. Beurskens,et al.  Responsiveness of functional status in low back pain: a comparison of different instruments , 1996, Pain.

[26]  P. Goldie,et al.  Deficit and change in gait velocity during rehabilitation after stroke. , 1996, Archives of physical medicine and rehabilitation.

[27]  S. Kaasa,et al.  Short Form 36 (SF-36) health survey: normative data from the general Norwegian population , 1998, Scandinavian journal of social medicine.

[28]  C. Bombardier,et al.  Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. , 2000, Spine.

[29]  G. Regehr,et al.  Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach. , 1997, Journal of clinical epidemiology.

[30]  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.

[31]  J. Wright,et al.  A comparison of different indices of responsiveness. , 1997, Journal of clinical epidemiology.

[32]  C. Sherbourne,et al.  The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. , 1994 .

[33]  F. T. de Dombal,et al.  Reliability and Reproducibility of Clinical Findings In Low-Back Pain , 1979, Spine.

[34]  R A Deyo,et al.  Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. , 1991, Controlled clinical trials.

[35]  N. Jacobson,et al.  Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance , 1984 .

[36]  Jorge L. Mendoza,et al.  A method of assessing change in a single subject: An alteration of the RC index , 1986 .

[37]  G. Waddell,et al.  Normality and reliability in the clinical assessment of backache. , 1982, British medical journal.

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

[39]  Jacob Cohen Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[40]  G. Guyatt,et al.  Measuring change over time: assessing the usefulness of evaluative instruments. , 1987, Journal of chronic diseases.

[41]  V. Seagroatt An introduction to medical statistics (2nd ed.) , 1996 .

[42]  Martin Bland,et al.  An Introduction to Medical Statistics , 1987 .

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

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

[45]  J. Jenner,et al.  Back Pain: New Approaches to Rehabilitation and Education , 1989 .