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The assessment of symptoms and functional limitations in low back pain patients: validity and reliability of a new questionnaire

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Abstract

Many of the existing low back pain (LBP) questionnaires of function and symptoms have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. The present study describes the development of a clinically derived back-specific questionnaire incorporating both a functional limitation and a symptom scale, with a further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aims of the study were to assess the overall reliability and validity of the new questionnaire, named the Profile Fitness Mapping questionnaire (PFM). A total of 193 chronic LBP patients answered the PFM together with five validated criterion questionnaires. For the internal consistency of the questionnaires, the three indices of the PFM had the highest Cronbach’s alpha (0.90–0.95) and all items had item–total correlations above 0.2. The correlation coefficients between the PFM and the back-specific criterion questionnaires ranged between 0.61 and 0.83, indicating good concurrent criterion validity. The best discriminative ability between patients with different pain severities was demonstrated by the functional limitation scale of the PFM. Well centered score distribution with no patient’s score at the floor or the ceiling level indicates that the PFM has the potential to detect the improvement or worsening of symptoms and functional limitations in chronic LBP patients. Classification according to the International Classification of Functioning, Disability and health (ICF) of WHO revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. The present study suggests that the PFM has a high internal consistency and is a valid indicator of symptoms and functional limitations of LBP patients. It offers the combination of a composite total score and the possibility of evaluations within specific domains of disability. Complementary evaluation of test–retest reliability and responsiveness to change is warranted.

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Acknowledgements

The authors would like to direct a special thank to physiologist Henrik Cyrén for most valuable help during the development of the Profile Fitness Mapping scales, Maria Frykman and Nisse Larson for valuable assistance during data collection, processing and analyses, and Margaretha Marklund for graphical work. The present study complies with the Swedish laws and was performed after obtaining advisory pronouncement by the Regional Ethical Review Board in Uppsala, Sweden, and informed consent from each subject.

Author information

Authors and Affiliations

  1. Centre for Musculoskeletal Research, University of Gävle, Box 7629, 907-12, Umeå, Sweden

    Martin Björklund, Marina Heiden & Margareta Barnekow-Bergkvist

  2. Alfta Research Foundation, Box 94, 822-22, Alfta, Sweden

    Martin Björklund & Jern Hamberg

Authors
  1. Martin Björklund
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  2. Jern Hamberg
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  3. Marina Heiden
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  4. Margareta Barnekow-Bergkvist
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Corresponding author

Correspondence to Martin Björklund.

Appendix: The profile fitness mapping questionnaire

Appendix: The profile fitness mapping questionnaire

The symptom scale

figure a

The functional limitation scale

figure b

Method of score calculation for the Profile Fitness Mapping scales

The table shows the weighting and maximum score of each item in the Profile Fitness Mapping scales, and the calculation of scores for each index.

Frequency (f) is the answer on how often the symptom is felt (six-point scale from 1 = never/very seldom, to 6 = very often/always). Intensity (i) is the answer on how much the symptom is felt (six-point scale from 7 = nothing/none at all, to 12 = almost unbearable/unbearable, all/maximally). The answers of the functional limitation scale (fl) range from 1 = very good, no problem, very satisfying, very likely, to 6 = very bad, very difficult/impossible, very dissatisfying, very unlikely.

The result of each index is expressed as the percentage of the maximum score, where 100% is the best possible result. Adjustments due to omitted questions are done by removing the maximum score for those questions from the denominator before calculating the percentage.

The symptom scale (s)

The functional limitation scale (fl)

Items

Weight (W s)

Score frequency index

Score intensity index

Max score

Itemfl

Weight (W fl)

Score function index

Max score

1

2.4

(6-f1)*W s

(12-i1)* W s

12

1

3

(6-fl1)*W fl

15

2

2

(6-f2)*W s

(12-i2)* W s

10

2

3

(6-fl2)*W fl

15

3

1.6

(6-f3)*W s

(12-i3)* W s

8

3

4

(6-fl3)*W fl

20

4

2

(6-f4)*W s

(12-i4)*W s

10

4

3

(6-fl4)*W fl

15

5

1.2

(6-f5)*W s

(12-i5)*W s

6

5

2

(6-fl5)*W fl

10

6

2.4

(6-f6)*W s

(12-i6)*W s

12

6

1.6

(6-fl6)*W fl

8

7

3

(6-f7)* W s

(12-i7)* W s

15

7

1.6

(6-fl7)*W fl

8

8

3

(6-f8)* W s

(12-i8)* W s

15

8

1.2

(6-fl8)*W fl

6

9

4

(6-f9)* W s

(12-i9)* W s

20

9

2

(6-fl9)*W fl

10

10

3

(6-f10)* W s

(12-i10)* W s

15

10

2.4

(6-fl10)* W fl

12

11

5

(6-f11)* W s

(12-i11)* W s

25

11

3

(6-fl11)* W fl

15

12

5

(6-f12)* W s

(12-i12)* W s

25

12

3

(6-fl12)* W fl

15

13

2

(6-f13)* W s

(12-i13)* W s

10

13

3

(6-fl13)*W fl

15

14

3

(6-f14)* W s

(12-i14)* W s

15

14

3

(6-fl14)* W fl

15

15

4

(6-f15)* W s

(12-i15)* W s

20

15

3

(6-fl15)* W fl

15

16

3

(6-f16)* W s

(12-i16)* W s

15

16

3

(6-fl16)* W fl

15

17

2

(6-f17)* W s

(12-i17)* W s

10

17

2

(6-fl17)* W fl

10

18

2

(6-f18)* W s

(12-i18)* W s

10

18

2.4

(6-fl18)* W fl

12

19

2

(6-f19)* W s

(12-i19)* W s

10

19

2

(6-fl19)* W fl

10

20

2.4

(6-f20)* W s

(12-i20)* W s

12

20

1.6

(6-fl20)* W fl

8

21

2

(6-f21)* W s

(12-i21)* W s

10

21

2

(6-fl21)* W fl

10

22

8

(6-f22)* W s

(12-i22)* W s

40

22

2

(6-fl22)* W fl

10

23

8

(6-f23)* W s

(12-i23)* W s

40

23

2

(6-fl23)* W fl

10

24

3.6

(6-f24)* W s

(12-i24)* W s

18

24

2

(6-fl24)* W fl

10

25

3.6

(6-f25)* W s

(12-i25)* W s

18

25

7

(6-fl25)* W fl

35

26

4

(6-f26)* W s

(12-i26)* W s

20

26

4

(6-fl26)* W fl

20

27

2.4

(6-f27)* W s

(12-i27)* W s

12

27

4

(6-fl27)* W fl

20

     

28

7

(6-fl28)* W fl

35

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Björklund, M., Hamberg, J., Heiden, M. et al. The assessment of symptoms and functional limitations in low back pain patients: validity and reliability of a new questionnaire. Eur Spine J 16, 1799–1811 (2007). https://doi.org/10.1007/s00586-007-0405-z

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