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


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.

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We would like to thank Christien Bird, Maureen MacDowell, Anne Golden and Mary Sexton for their contribution to the original investigation and the patients who participated in the study. The original trial was supported by the NHS Executive, South West Regional Office, Physical and Complex Disabilities National Programme. No additional funding was provided for this analysis. Ethical approval was obtained from the Brent and Harrow Health Authorities Research Ethics Committee

Conflict of interest statement

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subjects of this manuscript.

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Correspondence to Benedict Martin Wand.

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Wand, B.M., Chiffelle, L.A., O’Connell, N.E. et al. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain. Eur Spine J 19, 633–640 (2010).

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  • Low back pain
  • Disability
  • Functional performance
  • Validity
  • Outcome