European Spine Journal

, Volume 26, Issue 2, pp 301–308 | Cite as

The Roland–Morris Disability Questionnaire: one or more dimensions?

  • Tiê Parma YamatoEmail author
  • Chris G. Maher
  • Bruno T. Saragiotto
  • Mark J. Catley
  • James H. McAuley
Original Article



The Roland–Morris Disability Questionnaire (RMDQ) is one of the most recommended questionnaires to assess disability. Some previous studies support the assumption that the RMDQ is a unidimensional measure; however, recent studies have suggested that this measure has more than one domain and should be considered as a multidimensional scale. Therefore, the aim of this study was to analyse the structure of the RMDQ in a large sample of patients with low back pain using two different statistical approaches.


We analysed existing datasets from previous clinical studies. We assessed unidimensionality using Rasch analysis of item fit statistics and through principle component analysis of residuals. We also performed confirmatory factor analysis (CFA) to test the hypothesis of a 3-factor solution.


We included data from 2826 patients with non-specific low back pain. The average age of all participants included was 46.4 years, and half of the participants were women (50.1%). The Rasch analysis model showed that the RMDQ is unidimensional, with only two items demonstrating slight excessive positive outfit. Results from the CFA suggested poor fit to the data of a 3-factor solution.


We recommend that the RMDQ should still be used as a unidimensional scale for measuring disability as the only construct.


Low back pain Spine Factor analysis Psychometrics 



Tiê Parma Yamato is supported by CAPES (Coordination for the Improvement of Higher Education Personnel), Ministry of Education, Brazil. Bruno Tirotti Saragiotto is supported by CNPq (National Council for Scientific and Technological Development), Ministry of Science and Technology, Brazil. Chris Maher is supported by a Principal Research Fellowship from the National Health and Medical Research Council, Australia. The authors would like to thank Mr Aron Downie for assisting with statistical analysis. There is no funding source directly related to this study.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Beurskens AJ, de Vet HC, Koke AJ, van der Heijden GJ, Knipschild PG (1995) Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires. Spine (Phila Pa 1976) 20(9):1017–1028CrossRefGoogle Scholar
  2. 2.
    Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976) 25(24):3100–3103CrossRefGoogle Scholar
  3. 3.
    Ostelo RW, de Vet HC (2005) Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19(4):593–607. doi: 10.1016/j.berh.2005.03.003 CrossRefPubMedGoogle Scholar
  4. 4.
    Roland M, Fairbank J (2000) The Roland–Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 25(24):3115–3124CrossRefGoogle Scholar
  5. 5.
    Kopec JA (2000) Measuring functional outcomes in persons with back pain: a review of back-specific questionnaires. Spine (Phila Pa 1976) 25(24):3110–3114CrossRefGoogle Scholar
  6. 6.
    Grotle M, Wilkens P, Garratt AM, Scheel I, Storheim K (2013) Which Roland–Morris Disability Questionnaire? Rasch analysis of four different versions tested in a Norwegian population. J Rehabil Med 45(7):670–677. doi: 10.2340/16501977-1166 CrossRefPubMedGoogle Scholar
  7. 7.
    The Roland Morris Disability Questionnaire website. Accessed 7 Dec 2015
  8. 8.
    Macedo LG, Maher CG, Latimer J, Hancock MJ, Machado LA, McAuley JH (2011) Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire. Eur Spine J 20(3):458–463. doi: 10.1007/s00586-010-1608-2 CrossRefPubMedGoogle Scholar
  9. 9.
    Costa LO, Maher CG, Latimer J, Ferreira PH, Pozzi GC, Ribeiro RN (2007) Psychometric characteristics of the Brazilian–Portuguese versions of the Functional Rating Index and the Roland Morris Disability Questionnaire. Spine (Phila Pa 1976) 32(17):1902–1907. doi: 10.1097/BRS.0b013e31811eab33 CrossRefGoogle Scholar
  10. 10.
    Hiyama A, Watanabe M, Katoh H, Sato M, Sakai D, Mochida J (2016) Effect of depression and neuropathic pain using questionnaires on quality of life in patients with low back pain; cross-sectional retrospective study. Eur Spine J 25(9):2750–2760. doi: 10.1007/s00586-016-4432-5 CrossRefPubMedGoogle Scholar
  11. 11.
    Stratford PW, Riddle DL (2016) A Roland Morris Disability Questionnaire target value to distinguish between functional and dysfunctional states in people with low back pain. Physiother Can 68(1):29–35. doi: 10.3138/ptc.2014-85 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kent P, Grotle M, Dunn KM, Albert HB, Lauridsen HH (2015) Rasch analysis of the 23-item version of the Roland Morris Disability Questionnaire. J Rehabil Med 47(4):356–364. doi: 10.2340/16501977-1935 CrossRefPubMedGoogle Scholar
  13. 13.
    Garratt AM, United Kingdom Back Pain E, Manipulation T (2003) Rasch analysis of the Roland disability questionnaire. Spine (Phila Pa 1976) 28(1):79–84. doi: 10.1097/01.BRS.0000038164.82695.A3 CrossRefGoogle Scholar
  14. 14.
    Kucukdeveci AA, Tennant A, Elhan AH, Niyazoglu H (2001) Validation of the Turkish version of the Roland–Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976) 26(24):2738–2743CrossRefGoogle Scholar
  15. 15.
    Nambi SG (2013) Reliability, validity, sensitivity and specificity of Guajarati version of the Roland–Morris Disability Questionnaire. J Back Musculoskelet Rehabil 26(2):149–153. doi: 10.3233/BMR-2012-00359 CrossRefPubMedGoogle Scholar
  16. 16.
    Magnussen LH, Lygren H, Strand LI, Hagen EM, Breivik K (2015) Reconsidering the Roland–Morris Disability Questionnaire: time for a multidimensional framework? Spine (Phila Pa 1976) 40(4):257–263. doi: 10.1097/BRS.0000000000000705 CrossRefGoogle Scholar
  17. 17.
    Chen WH, Lenderking W, Jin Y, Wyrwich KW, Gelhorn H, Revicki DA (2014) Is Rasch model analysis applicable in small sample size pilot studies for assessing item characteristics? An example using PROMIS pain behavior item bank data. Qual Life Res 23(2):485–493. doi: 10.1007/s11136-013-0487-5 CrossRefPubMedGoogle Scholar
  18. 18.
    Bond T, Fox C (2007) Applying the Rasch model: fundamental measurement in the human sciences, 2nd edn. Lawrence Erlbaum, MahwahGoogle Scholar
  19. 19.
    Tennant A, Conaghan PG (2007) The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum 57(8):1358–1362. doi: 10.1002/art.23108 CrossRefPubMedGoogle Scholar
  20. 20.
    Yu CY (2002) Evaluating cutoff criteria of model fit indices for latent variable models with binary and continous outcomes. University of California, Los AngelesGoogle Scholar
  21. 21.
    Davidson M (2009) Rasch analysis of 24-, 18- and 11-item versions of the Roland–Morris Disability Questionnaire. Qual Life Res 18(4):473–481. doi: 10.1007/s11136-009-9456-4 CrossRefPubMedGoogle Scholar
  22. 22.
    Stroud MW, McKnight PE, Jensen MP (2004) Assessment of self-reported physical activity in patients with chronic pain: development of an abbreviated Roland–Morris disability scale. J Pain 5(5):257–263. doi: 10.1016/j.jpain.2004.04.002 CrossRefPubMedGoogle Scholar
  23. 23.
    Mielenz TJ, Carey TS, Edwards MC (2015) Item response theory analysis of the modified Roland–Morris Disability Questionnaire in a population-based study. Spine (Phila Pa 1976) 40(6):E366–E371. doi: 10.1097/BRS.0000000000000764 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Tiê Parma Yamato
    • 1
    Email author
  • Chris G. Maher
    • 1
  • Bruno T. Saragiotto
    • 1
  • Mark J. Catley
    • 2
  • James H. McAuley
    • 3
    • 4
  1. 1.Musculoskeletal Division, The George Institute for Global Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  2. 2.Sansom Institute for Health ResearchUniversity of South AustraliaAdelaideAustralia
  3. 3.Neuroscience Research AustraliaSydneyAustralia
  4. 4.Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia

Personalised recommendations