Original Article

European Spine Journal

, Volume 19, Issue 4, pp 633-640

First online:

Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain

  • Benedict Martin WandAffiliated withSchool of Health Sciences, The University of Notre Dame Australia Email author 
  • , Lara A. ChiffelleAffiliated withProgress Physiotherapy Services
  • , Neil Edward O’ConnellAffiliated withDepartment of Health Sciences and Social Care, Brunel University
  • , James Henry McAuleyAffiliated withMusculoskeletal Division, The George Institute for International Health
  • , Lorraine Hilary DeSouzaAffiliated withDepartment of Health Sciences and Social Care, Brunel University

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For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach’s alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson’s correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson’s correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach’s alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient’s psychological status than performance-based measures of disability.


Low back pain Disability Functional performance Validity Outcome