European Spine Journal

, Volume 20, Issue 3, pp 458–463 | Cite as

Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire

  • Luciana Gazzi MacedoEmail author
  • Chris G. Maher
  • Jane Latimer
  • Mark J. Hancock
  • Luciana A. C. Machado
  • James H. McAuley
Original Article


Several versions of the 24-item Roland Morris Disability Questionnaire (RMDQ) have been proposed; however, their responsiveness has not been extensively explored. The objective of this study was to compare the responsiveness of four versions of the RMDQ. Perceived disability was measured using the 24-item, two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six randomised controlled trials. Responsiveness was calculated using effect size, Guyatt’s responsiveness index (GRI) and receiver operating characteristics (ROC) curves. Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ. GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item. ROC curves revealed that the 11-item was less responsive than the other three versions, which had similar responsiveness. The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item.


Low back pain Questionnaires ROC curve Validity 



Luciana Macedo holds a PhD scholarship jointly funded by the University of Sydney and the Australian Government. Chris Maher’s research fellowship is funded by Australia’s National Health and Medical Research Council. Jane Latimer’s research fellowship is funded by the Australian Research Council. Luciana Machado’s postdoctoral fellowship is funded by Fundação de Amparo à Pesquisa do Estado de Minas Gerais, FAPEMIG, Brazil.

Conflict of interest



  1. 1.
    Roland M, Morris R, Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144PubMedCrossRefGoogle Scholar
  2. 2.
    Guyatt G, Walter S, Norman G (1987) Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:171–178PubMedCrossRefGoogle Scholar
  3. 3.
    Lauridsen HH, Hartvigsen J, Manniche C, Korsholm L, Grunnet-Nilsoon N (2006) Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients. BMC Musculoskelet Disord 7:1–16CrossRefGoogle Scholar
  4. 4.
    Jordan K, Dunn KM, Lewis M, Croft P (2006) A minimal clinically important difference was derived for the Roland–Morris disability questionnaire for low back pain. J Clin Epidemiol 59:45–52PubMedCrossRefGoogle Scholar
  5. 5.
    Stroud MW, McKnight PE, Jensen MP (2004) Assessment of self-reported physical activity in patients wiht chronic pain: development of an abbreviated Roland–Morris disability scale. J Pain 5:257–263PubMedCrossRefGoogle Scholar
  6. 6.
    Stratford PW, Binkley JM (1997) Measurement properties of the RM-18. A modified version of the Roland–Morris disability scale. Spine 22:2416–2421PubMedCrossRefGoogle Scholar
  7. 7.
    Williams RM, Myers AM (2001) Support for a shortened Roland–Morris Disability Questionnaire for patietns with acute low back pain. Physiother Can 53:60–66Google Scholar
  8. 8.
    Brouwer S, Kuijer W, Dijkstra P, Goeken L, Groothoff J, Geertzen J (2004) Reliability and stability of the Roland Morris disability questionnaire: intra class correlation and limits of agreement. Disabil Rehabil 26:162–165PubMedCrossRefGoogle Scholar
  9. 9.
    Ostelo RWJG, de Vet HCW, Knol DL, van den Brandt PA (2004) 24-item Roland Morris disability questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol 57:268–276PubMedCrossRefGoogle Scholar
  10. 10.
    Riddle DL, Stratford PW (2002) Roland-Morris scale reliability. Phys Ther 82:512–515 (author reply 515–517)PubMedGoogle Scholar
  11. 11.
    Chansirinukor W, Maher CG, Latimer J, Hush J (2005) Comparison of the functional rating index and the 18-item Roland–Morris disability questionnaire: responsiveness and reliability. Spine 30:141–145PubMedGoogle Scholar
  12. 12.
    Pengel LHM, Refshauge KM, Maher CG, Nicholas MK, Herbert RD, McNair P (2007) Physiotherapist-directed exercise, advice, or both for subacute low back pain: a randomized trial. Ann Intern Med 146:787–796PubMedGoogle Scholar
  13. 13.
    Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, Spindler MF, McAuley JH (2007) Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet 370:1638–1643PubMedCrossRefGoogle Scholar
  14. 14.
    Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, McAuley JH, Stafford R (2008) Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskelet Disord 9 [Epub ahead of print]Google Scholar
  15. 15.
    Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM, Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM (2007) Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain 131:31–37PubMedCrossRefGoogle Scholar
  16. 16.
    Costa LOP, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, McAuley JH, Jennings MD (2009) Motor control exercises for chronic low back pain: a randomized placebo-controlled trial. Phys Ther 89:1275–1286PubMedCrossRefGoogle Scholar
  17. 17.
    Machado LAC, Maher CG, Herbert RD, Clare H, McAuley JH (2010) The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC Med 8:10PubMedCrossRefGoogle Scholar
  18. 18.
    Machado LAC, Kamper SJ, Herbert RD, Maher CG, Mcauley JH (2009) Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology 48:520–527PubMedCrossRefGoogle Scholar
  19. 19.
    Cheng A. The HONG KONG ROC program: Chinese University of Hong Kong, Department of Obstetrics and Gynecology.
  20. 20.
    Pengel LHM, Refshauge KM, Maher CG (2004) Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine 29:879–883PubMedCrossRefGoogle Scholar
  21. 21.
    Tryon W (2001) Evaluating statistical difference, equivalence, and indeterminancy using inferential confidence intervals: an integrated alternative method of conducting null hypothesis statistical tests. Psychol Methods 6:371–386PubMedCrossRefGoogle Scholar
  22. 22.
    Cohen J, Cohen P (1983) Applied multiple regression/correlation analysis for the behavioral sciences. Erlbaum Associates, HillsdaleGoogle Scholar
  23. 23.
    DeLong E, DeLong D, Clarke-Pearson D (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRefGoogle Scholar
  24. 24.
    Davidson M (2009) Rasch analysis of 24- 18- and 11-item versions of the Roland–Morris disability questionnaire. Qual Life Res 18:473–481PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Luciana Gazzi Macedo
    • 1
    Email author
  • Chris G. Maher
    • 1
  • Jane Latimer
    • 1
  • Mark J. Hancock
    • 2
  • Luciana A. C. Machado
    • 3
  • James H. McAuley
    • 4
  1. 1.The George Institute for Global HealthThe University of SydneySydneyAustralia
  2. 2.The Faculty of Health SciencesThe University of SydneyLidcombeAustralia
  3. 3.Escola de Educação Física, Fisioterapia e Terapia OcupacionalUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  4. 4.Neuroscience Research AustraliaThe University of New South WalesSydneyAustralia

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