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The patient-specific functional scale is more responsive than the Roland Morris disability questionnaire when activity limitation is low

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Abstract

The primary objective of this study was to determine which questionnaire, the Roland Morris disability questionnaire (RMDQ) or the patient-specific functional scale (PSFS), was better at detecting change in activity limitation in a large cohort of patients with low back pain undergoing rehabilitation. A secondary aim was to determine if the responsiveness of the questionnaires was influenced by the patient’s level of activity limitation at baseline. Responsiveness statistics, including effect size statistics, Pearson’s r correlations and receiver operative characteristic (ROC) curve analysis were used to determine ability to detect change in activity limitation on 831 patients with low back pain. Data were analysed at two time points; directly after treatment (termed short-term) and several weeks post-treatment (termed mid-term). The data were subsequently re-analysed on sub-sets of the full cohort according to the level of activity limitation from RMDQ baseline scores. In the total cohort we found that the PSFS was more responsive than the RMDQ; however, in the subgroup with high activity limitation this pattern was not observed. This is true for time points up to 6 months post-treatment. In conclusion, the RMDQ and PSFS both demonstrate good responsiveness according to the definitions given in previous guidelines. The PSFS is more responsive than the RMDQ for patients with low levels of activity limitation but not for patients with high levels of activity limitation.

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References

  1. Morris R (1983) A study of the natural-history of back pain.1. Development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144

    Article  PubMed  Google Scholar 

  2. Stratford P, Gill C, Westaway M, Binkley J (1995) Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can 47:258–263

    Article  Google Scholar 

  3. Stratford PW, Binkley J, Solomon P, Gill C, Finch E (1994) Assessing change over time in patients with low back pain. Phys Ther 74:528–533

    CAS  PubMed  Google Scholar 

  4. Guyatt G, Walter S, Shannon H, Cook D, Jaeschke R, Heddle N (1995) Basic statistics for clinican. 4. Correlation and regression. Can Med Assoc J 152:497–504

    CAS  Google Scholar 

  5. Chou R, Huffman LH (2007) Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American pain Society/American college of physicians clinical practice guideline. Ann Intern Med 147:492–504

    PubMed  Google Scholar 

  6. 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 48:520–527. doi:10.1093/rheumatology/ken470

    Article  CAS  PubMed  Google Scholar 

  7. Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    Article  CAS  PubMed  Google Scholar 

  8. Beurskens AJ, de Vet HC, Koke AJ, Lindeman E, van der Heijden GJ, Regtop W et al (1999) A patient specific approach for measuring functional status in low back pain. J Manip Physiol Ther 22:144–148

    Article  CAS  Google Scholar 

  9. Costa LOP, Maher CG, Latimer J, Ferreira PH, Ferreira ML, Pozzi GC et al (2008) Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil. Spine 33:2459–2463

    Article  PubMed  Google Scholar 

  10. Frost H, Lamb S, Stewart-Brown S (2008) Responsiveness of a patient specific outcome measure compared with Oswestry disability index v2.1 and Roland Morris disability questionnaire for patients with subacute and chronic low back pain. Spine 33:2450–2457

    Article  PubMed  Google Scholar 

  11. Pengel LHM, Refshauge KM, Maher CG (2004) Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine 29:879–883

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Terwee CB, Bot SDM, de Boer MR, van der Windt D, Knol DL, Dekker J et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  14. Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD et al (2007) Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain 131:31–37

    Article  PubMed  Google Scholar 

  15. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO et al (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 370:1638–1643

    Article  CAS  PubMed  Google Scholar 

  16. Maher C, Latimer J, Hodges P, Refshauge K, Moseley L, Herbert RD et al (2005) The effect of motor control exercise versus placebo in patients with chronic low back pain [ACTRN012605000262606]. BMC Musculoskelet Disord 6(ARTN 54):1–8. doi:10.1186/1471-2474-6-54

    Google Scholar 

  17. 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 146:787–796

    PubMed  Google Scholar 

  18. Stratford PW, Binkley JM, Riddle DL (2000) Development and initial validation of the back pain functional scale. Spine 25:2095–2102

    Article  CAS  PubMed  Google Scholar 

  19. Costa LDM, Henschke N, Maher CG, Refshauge KM, Herbert RD, McAuley JH et al (2007) Prognosis of chronic low back pain: design of an inception cohort study. BMC Musculoskelet Disord 8(ARTN 11):1–4

    Google Scholar 

  20. Higgins J, Green S (2008) Cochrane handbook for systematic reviews of interventions version 5.0.0. The Cochrane Collaboration

  21. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721

    PubMed  Google Scholar 

  22. Payton ME, Miller AE, Raun WR (2000) Testing statistical hypotheses using standard error bars and confidence intervals. Commun Soil Sci Plant Anal 31:547–551

    Article  CAS  Google Scholar 

  23. Kamper SJ, Maher CG, Mackay G (2009) Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther 17 (in press)

  24. Cohen J, Cohen P (1983) Applied multiple regression/correlation analysis for the behavioral sciences. L. Erlbaum Associates, Hillsdale

    Google Scholar 

  25. Cheng A. The HONG KONG ROC program. http://department.obg.cuhk.edu.hk/researchsupport/statmenu.asp

  26. Delong ER, Delong DM, Clarkepearson DI (1988) Comparing the areas under two or more correlated receiver operating characteristic curves—a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  27. Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ (2009) Factors defining care-seeking in low back pain—a meta-analysis of population based surveys. Eur J Pain (in press)

  28. Costa LOP, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM et al (2009) Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther 89:1275–1286

    Article  PubMed  Google Scholar 

  29. Cohen J (1988) Statistical power analysis for the behavioural sciences. L. Erlbaum Associates, Hillsdale

    Google Scholar 

  30. Tyron W (2001) Evaluating statistical difference, equivalence, and indeterminacy using inferential confidence intervals: an intergrated alternative method of conducting null hypothesis statistical tests. Psychol Methods 6:371–386

    Article  Google Scholar 

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Correspondence to Amanda M. Hall.

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Hall, A.M., Maher, C.G., Latimer, J. et al. The patient-specific functional scale is more responsive than the Roland Morris disability questionnaire when activity limitation is low. Eur Spine J 20, 79–86 (2011). https://doi.org/10.1007/s00586-010-1521-8

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  • DOI: https://doi.org/10.1007/s00586-010-1521-8

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