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A modified Roland–Morris disability scale for the assessment of sciatica

  • Clinical Article
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Abstract

Background

The Roland–Morris disability scale (RMS) for disability secondary to low back pain is a validated and popular instrument in clinical practice and research. We have made a simple modification to the questionnaire to increase sensitivity to sciatica (RMS-L) and validated this in patients with lumbar disc prolapse and radiculopathy.

Methods

The original RMS and modified RMS-L were prospectively administered to 203 patients presenting with lumbar radiculopathy and intervertebral disc prolapse demonstrated on MRI. Scores at pre-operative assessment and follow-up at 3 months and 12–24 months were compared against visual analogue scores (VAS) and Short Form 36 generic health domains.

Findings

Correlation between RMS-L and VAS leg pain was significantly greater than between original RMS and VAS leg pain pre-operatively (r = 0.57 vs. 0.17, p < 0.001) and at 3 months follow-up (r = 0.78 vs. 0.49, p < 0.001). Conversely, correlation between RMS and VAS back pain was significantly higher (r = 0.58 vs. 0.15, p < 0.001). Compared with RMS, at pre-operative assessment, RMS-L showed greater correlation with SF-36 physical function (PF; r = −0.57 vs. −0.32, p < 0.001) and bodily pain (r = −0.58 vs. −0.35, p < 0.001). Similarly, the change in PF to 3 months follow-up showed significantly higher correlation with change in RMS-L compared with the change in RMS (r = −0.60 vs. −0.37, p < 0.001). Effect sizes were good for RMS-L (1.19–1.24) but only moderate for RMS (0.69–0.79).

Conclusions

The original and modified RMS can discriminate disability due to low back pain and sciatica, respectively. Separate assessment of these symptoms and their contribution to functional impairment is useful in assessing suitability for surgery and predicting outcome.

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Abbreviations

BP:

Bodily pain

PF:

Physical function

RMS:

Roland–Morris disability questionnaire (original version)

RMS-L:

Modified Roland disability questionnaire

SF-36:

Medical outcomes survey short form 36-item health questionnaire

SRM:

Standardised response mean

VAS-B:

Visual analogue score for back pain

VAS-L:

Visual analogue score for leg pain

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Authors and Affiliations

  1. Department of Neurosurgery, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK

    Min Kim, Mathew R. Guilfoyle, Helen M. Seeley & Rodney J. C. Laing

Authors
  1. Min Kim
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  2. Mathew R. Guilfoyle
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  3. Helen M. Seeley
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  4. Rodney J. C. Laing
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Corresponding author

Correspondence to Rodney J. C. Laing.

Additional information

Comments

The authors administered multiple tests to 203 patients who underwent lumbar discectomy. They correlated the patients’ scores on the Roland modified disability scale (RMS) and on a modified RMS-L to scores on the VAS. The correlation between the RMS-L and VAS leg pain was significantly greater between the original RMS and VAS for pre-operative leg pain and a 3-month follow-up than on the modified RMS-L. Similarly, the correlation between the original RMS and VAS back pain was significantly higher than on the modified version. However, the RMS-L correlated best with other outcome tests. Consequently, the authors conclude that the original and modified RMS can discriminate disabilities related to lower back pain and sciatica, respectively. Separate assessment of these symptoms and the contribution to functional impairment is useful in assessing suitable surgical treatments and predicting outcomes.

Volker Sonntag

Phoenix, AZ, USA

Appendix

Appendix

Combined RMS (A) and RMS-L (B) Questionnaire (modified from [12]).

Each item response is YES/NO, with positive response scoring 1 point. Total score is 0–24 for each scale.

  1. 1
    1. A)

      I stay at home most of the time because of my back.

    2. B)

      I stay at home most of the time because of my leg.

  2. 2
    1. A)

      I change position frequently to try and get my back comfortable.

    2. B)

      I change position frequently to try and get my leg comfortable.

  3. 3
    1. A)

      I walk more slowly than usual because of my back.

    2. B)

      I walk more slowly than usual because of my leg.

  4. 4
    1. A)

      Because of my back, I am not doing any of the jobs that I usually do around the house.

    2. B)

      Because of my leg, I am not doing any of the jobs that I usually do around the house.

  5. 5
    1. A)

      Because of my back, I use a handrail to get upstairs.

    2. B)

      Because of my leg, I use a handrail to get upstairs.

  6. 6
    1. A)

      Because of my back, I lie down to rest more often.

    2. B)

      Because of my leg, I lie down to rest more often.

  1. 7
    1. A)

      Because of my back, I have to hold on to something to get out of an easy chair.

    2. B)

      Because of my leg, I have to hold on to something to get out of an easy chair.

  2. 8
    1. A)

      Because of my back, I try to get other people to do things for me.

    2. B)

      Because of my leg, I try to get other people to do things for me.

  1. 9
    1. A)

      I get dressed more slowly than usual because of my back.

    2. B)

      I get dressed more slowly than usual because of my leg.

  2. 10
    1. A)

      I only stand up for short periods of time because of my back.

    2. B)

      I only stand up for short periods of time because of my leg.

  3. 11
    1. A)

      Because of my back, I try not to bend or kneel down.

    2. B)

      Because of my leg, I try not to bend or kneel down.

  4. 12
    1. A)

      I find it difficult to get out of a chair because of my back.

    2. B)

      I find it difficult to get out of a chair because of my leg.

  5. 13
    1. A)

      My back is painful almost all of the time.

    2. B)

      My leg is painful almost all of the time.

  6. 14
    1. A)

      I find it difficult to turn over in bed because of my back.

    2. B)

      I find it difficult to turn over in bed because of my leg.

  7. 15
    1. A)

      My appetite is not very good because of my back pain.

    2. B)

      My appetite is not very good because of my leg pain.

  8. 16
    1. A)

      I have trouble putting on my socks (or stockings) because of pain in my back.

    2. B)

      I have trouble putting on my socks (or stockings) because of pain in my leg.

  9. 17
    1. A)

      I only walk short distances because of my back pain.

    2. B)

      I only walk short distances because of my leg pain.

  10. 18
    1. A)

      I sleep less well because of my back.

    2. B)

      I sleep less well because of my leg.

  11. 19
    1. A)

      Because of my back pain, I get dressed with help from someone else.

    2. B)

      Because of my leg pain, I get dressed with help from someone else.

  12. 20
    1. A)

      I sit down for most of the day because of my back.

    2. B)

      I sit down for most of the day because of my leg.

  13. 21
    1. A)

      I avoid heavy jobs around the house because of my back.

    2. B)

      I avoid heavy jobs around the house because of my leg.

  14. 22
    1. A)

      Because of my back pain, I am more irritable and bad tempered with people than usual.

    2. B)

      Because of my leg pain, I am more irritable and bad tempered with people than usual.

  15. 23
    1. A)

      Because of my back, I go upstairs more slowly than usual.

    2. B)

      Because of my leg, I go upstairs more slowly than usual.

  16. 24
    1. A)

      I stay in bed most of the time because of my back.

    2. B)

      I stay in bed most of the time because of my leg.

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Kim, M., Guilfoyle, M.R., Seeley, H.M. et al. A modified Roland–Morris disability scale for the assessment of sciatica. Acta Neurochir 152, 1549–1553 (2010). https://doi.org/10.1007/s00701-010-0679-5

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  • DOI: https://doi.org/10.1007/s00701-010-0679-5

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