Skip to main content


Log in

Validity of the French version of the Core Outcome Measures Index for low back pain patients: a prospective cohort study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript



Among the many questionnaires available to evaluate low back pain (LBP) patients, the Core Outcome Measures Index (COMI) has the unique advantage to investigate five dimensions using seven short questions. The aim of this study was to explore additional properties of the questionnaire in a French-speaking non-surgical population.


This study was conducted on 168 patients suffering from subacute or chronic LBP and followed up for 6 months in three French-speaking countries. In addition to basic psychometric properties (e.g., construct validity, floor and ceiling effect, reproducibility), internal validity was analyzed by a factor analysis using Cronbach’s alpha. Responsiveness and sensitivity to change were assessed through minimal detectable change (MDC), effect size, and Minimal Clinically Important Improvement (MCII). We used an anchor-based method with receiver operating characteristic (ROC) curve analysis to assess MCII and the Patient Acceptable Symptom State.


Construct validity, reliability (Cronbach’s alpha = 0.87), reproducibility and the absence of floor and ceiling effects were confirmed. Factor analysis indicated a one-dimensional construct that validates the use of a sum score. The MDC (2.1) was inferior to the MCII (2.3). The limit below which the patient claims to be in a fair condition (Patient Acceptable Symptom State) was set at 3.


The COMI is a self-report questionnaire with the capacity to easily and quickly explore several dimensions in patients with LBP that can be then summarized in a meaningful sum score. Additional knowledge provided by our study should encourage the widespread use of the COMI among the spine community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Cleland JJ, Gillani RR, Bienen EJR, Sadosky AA (2011) Assessing dimensionality and responsiveness of outcomes measures for patients with low back pain. Pain pract 11(1):57–69

    Article  PubMed  Google Scholar 

  2. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23(18):2003–2013

    Article  PubMed  CAS  Google Scholar 

  3. Ferrer M, Pellise F, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine 31(12):1372–1379 discussion 1380

    Article  PubMed  Google Scholar 

  4. Genevay S, Cedraschi C, Marty M, Rozenberg S, De-Goumons P, Faundez A, Balagu F, Porchet F, Mannion AFA (2012) Reliability and validity of the cross-culturally adapted French version of the core outcome measures index (COMI) in patients with low back pain. Eur Spine J 21(1):130–137

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026

    Article  PubMed  Google Scholar 

  6. Roeder C, Chavanne A, Mannion AF, Grob D, Aebi M (2005) SSE Spine Tango–content, workflow, set-up. Tango. Eur Spine J 14(10):920–924

    Article  Google Scholar 

  7. Kvien TK, Heiberg T, Hagen KB (2007) Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis 66(Suppl 3):iii40–iii41

    PubMed  PubMed Central  Google Scholar 

  8. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42

    Article  PubMed  Google Scholar 

  9. Storheim K, Brox JI, Lochting I, Werner EL, Grotle M (2012) Cross-cultural adaptation and validation of the Norwegian version of the Core Outcome Measures Index for low back pain. Eur Spine J 21(12):2539–2549

    Article  PubMed  PubMed Central  Google Scholar 

  10. Coste J, Le Parc JM, Berge E, Delecoeuillerie G, Paolaggi JB (1993) French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire). Rev Rhum Ed Fr 60(5):335–341

    PubMed  CAS  Google Scholar 

  11. Marty M, Blotman F, Avouac B, Rozenberg S, Valat JP (1998) Validation of the French version of the Dallas Pain Questionnaire in chronic low back pain patients. Rev Rhum Engl Ed 65(2):126–134

    PubMed  CAS  Google Scholar 

  12. Perneger TV, Combescure C, Courvoisier DS (2010) General population reference values for the French version of the EuroQol EQ-5D health utility instrument. Value Health 13(5):631–635

    Article  PubMed  Google Scholar 

  13. Beurskens AJ, de Vet HC, Koke AJ (1996) Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 65(1):71–76

    Article  PubMed  CAS  Google Scholar 

  14. Tubach F, Ravaud P, Beaton D, Boers M, Bombardier C, Felson DT, van der Heijde D, Wells G, Dougados M (2007) Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol 34(5):1188–1193

    PubMed  PubMed Central  Google Scholar 

  15. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  16. Steiner D, Norman G (1995) Health measurement scales: a practical guide to their development and use. Oxford Medical Publications, Oxford

    Google Scholar 

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  PubMed  CAS  Google Scholar 

  18. Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports med 30(1):1–15

    Article  PubMed  CAS  Google Scholar 

  19. Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 64(1):29–33

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Tubach F, Wells GA, Ravaud P, Dougados M (2005) Minimal clinically important difference, low disease activity state, and patient acceptable symptom state: methodological issues. J Rheumatol 32(10):2025–2029

    PubMed  Google Scholar 

  21. Qiao J, Zhu F, Zhu Z, Xu L, Wang B, Yu Y, Qian BP, Ding Y, Qiu Y (2013) Validation of the simplified Chinese version of the Core Outcome Measures Index (COMI). Eur Spine J 22(12):2821–2826

    Article  PubMed  Google Scholar 

  22. Escobar A, Gonzalez M, Quintana JM, Vrotsou K, Bilbao A, Herrera-Espineira C, Garcia-Perez L, Aizpuru F, Sarasqueta C (2012) Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthr Cartil 20(2):87–92

    Article  PubMed  CAS  Google Scholar 

  23. Tubach F, Dougados M, Falissard B, Baron G, Logeart I, Ravaud P (2006) Feeling good rather than feeling better matters more to patients. Arthritis Rheum 55(4):526–530

    Article  PubMed  Google Scholar 

  24. Tubach F, Pham T, Skomsvoll JF, Mikkelsen K, Bjorneboe O, Ravaud P, Dougados M, Kvien TK (2006) Stability of the patient acceptable symptomatic state over time in outcome criteria in ankylosing spondylitis. Arthritis Rheum 55(6):960–963

    Article  PubMed  Google Scholar 

  25. Hochberg MCM, Wohlreich MM, Gaynor PP, Hanna SS, Risser RR (2011) Clinically relevant outcomes based on analysis of pooled aata from 2 trials of Duloxetine in patients with knee Osteoarthritis. J Rheumatol 39(2):352–358

    Article  PubMed  Google Scholar 

  26. Quintana JMJ, Aguirre UU, Barrio II, Orive MM, Garcia SS, Escobar AA (2011) Outcomes after total hip replacement based on patients’ basal status, what results you can expect. Arthritis Care Res (Hoboken) 64(4):563–572

    Article  Google Scholar 

  27. Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mannion AF, Boneschi M, Teli M, Luca A, Zaina F, Negrini S, Schulz PJ (2012) Reliability and validity of the cross-culturally adapted Italian version of the Core Outcome Measures Index. Eur Spine J 21(Suppl 6):S737–S749

    Article  PubMed  Google Scholar 

  29. Miekisiak G, Banach M, Kiwic G, Kubaszewski L, Kaczmarczyk J, Sulewski A, Kloc W, Libionka W, Latka D, Kollataj M, Zaluski R (2014) Reliability and validity of the Polish version of the Core Outcome Measures Index for the neck. Eur Spine J 23(4):898–903

    Article  PubMed  PubMed Central  Google Scholar 

Download references


We thank all the team from “Nukleus” and, in particular, Mrs V. Gordin and M. Demonnet for their help and logistic support. We wish also to thank members of the Spine section of the French Rheumatology Society for their support in recruiting patients and Pfizer AG for their financial support. This study was supported by an unrestricted educational grant from Pfizer.

Conflict of interest


Author information

Authors and Affiliations



Corresponding author

Correspondence to Stéphane Genevay.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 23 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Genevay, S., Marty, M., Courvoisier, D.S. et al. Validity of the French version of the Core Outcome Measures Index for low back pain patients: a prospective cohort study. Eur Spine J 23, 2097–2104 (2014).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: