The validity and reliability of the functional rating index for evaluating low back pain in athletes. Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials A randomized, single blind placebo controlled clinical trial on the effect of continuous ultrasound on low back pain. Can Primary Care for Back and/or Neck Pain in the Netherlands Benefit From Stratification for Risk Groups According to the STarT Back Tool Classification? Development and Initial Validation of the Back Pain Functional Scale The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions PROMIS PF CAT Outperforms the ODI and SF-36 Physical Function Domain in Spine Patients Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Cervical Spine Outcomes Questionnaire: Its Development and Psychometric Properties Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4) Randomized Controlled Trial of Specific Spinal Stabilization Exercises and Conventional Physiotherapy for Recurrent Low Back Pain Electronic pain questionnaires: A randomized, crossover comparison with paper questionnaires for chronic pain assessment A menopause-specific quality of life questionnaire: development and psychometric properties. Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population Validation of the French version of the Bournemouth Questionnaire. Outcome measures in chronic low back pain Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study What are possible barriers and facilitators to implementation of a Participatory Ergonomics programme? A study of therapeutic ultrasound and exercise treatment for muscle fatigue in patients with chronic non specific low back pain: a preliminary report. Reliability and Validity of the Persian Versions of the Fear Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Neck Pain Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease
The purpose of the present study was to determine the reliability and validity of the Functional Rating Index ( FRI ) for athletes with low back pain ( LBP ) . In this cross-sectional and prospect i ve cohort study , the vali date d Persian FRI ( PFRI ) was tested in 100 athletes with LBP and 50 healthy athletes . From the athletes with LBP , data were recollected among 50 athletes with a 7-day interval to examine test-retest reliability . The content validity was excellent , and the athletes with LBP responded to all items with no floor or ceiling effects . The discriminative validity was supported by a statistically significant difference in PFRI total scores between the athletes with LBP and healthy athletes . The concurrent criterion validity was good ( rho = 0.72 ) . The construct , convergent validity was good ( r = 0.83 ) . The internal consistency reliability estimate was high ( Cronbach 's α = 0.90 ) . Factor analysis demonstrated a single-factor structure with an explained variance of 52.22 % . The test-retest reliability was excellent , indicated by an ICC(agreement ) of 0.97 , and the agreement observed in the Bl and and Altman plot demonstrated no systematic bias . It is concluded that the PFRI has excellent psychometric properties for assessing athletes with LBP Background Low back pain ( LBP ) and neck pain ( NP ) are common conditions in old age , leading to impaired functional ability and decreased independence . Manual and exercise therapies are common and effective therapies for the general LBP and NP population s. However , these treatments have not been adequately research ed in older LBP and NP sufferers . The primary aim of these studies is to assess the relative clinical effectiveness of 1 ) manual treatment plus home exercise , 2 ) supervised rehabilitative exercise plus home exercise , and 3 ) home exercise alone , in terms of patient-rated pain , for senior LBP and NP patients . Secondary aims are to compare the three treatment approaches in regards to patient-rated disability , general health status , satisfaction , improvement and medication use , as well as objective outcomes of spinal motion , trunk strength and endurance , and functional ability . Cost-effectiveness and cost-utility will also be assessed . Finally , using qualitative methods , older LBP and NP patient 's perceptions of treatment will be explored and described . Methods / Design This paper describes the design of two multi- methods clinical studies focusing on elderly patients with non-acute LBP and NP . Each study includes a r and omized clinical trial ( RCT ) , a cost-effectiveness study alongside the RCT , and a qualitative study . Four hundred and eighty participants ( 240 per study ) , ages 65 and older , will be recruited and r and omized to one of three , 12-week treatment programs .  Patient-rated outcome measures are collected via self-report question naires at baseline and at 4 , 12 , 26 , and 52 weeks post-r and omization . Objective outcomes are assessed by examiners masked to treatment assignment at baseline and 12 weeks . Health care cost data is collected through st and ardized clinician forms , monthly phone interviews , and self-report question naires throughout the study . Qualitative interviews using a semi-structured format are conducted at the end of the 12 week treatment period . Discussion To our knowledge , these are the first r and omized clinical trials to comprehensively address clinical effectiveness , cost-effectiveness , and patients ' perceptions of commonly used treatments for elderly LBP and NP sufferers . Trial Registration NCT00269321 and Low back pain ( LBP ) is a very common problem in primary care and a major cause of disability . There is no evidence for the efficacy of therapeutic modalities such as ultrasound in LBP In a r and omized , single blind placebo controlled clinical trial , we aim ed to evaluate the effect of continuous ultrasound ( US ) in patients with non specific LBP Of the fifty eight patients recruited , 10 patients ( 8 women and 2 men ) r and omly allocated to  ultrasound  ( n=5 ) or placebo controlled ( n=5 ) groups . The patients were treated by either US or sham-US for ten sessions , three days per week , every other day . The outcome measures were Functional Rating Index ( FRI ) , Hmax/Mmax ratio and range of motion ( ROM ) , which were measured at baseline , after 5 treatment sessions and at the end of treatment . To analyze the data , The Mann Whitney U test and Wilcoxon Signed Rank test were used . After treatment , both US and placebo groups showed statistically significant decrease in FRI scores indicating improvement in functional ability ( p = 0.042 and p = 0.043 , respectively ) . The mean changes of FRI during the second five treatment sessions and after the end of treatment was significantly better in the US group than in the placebo group ( p = 0.016 and p = 0.032 , respectively ) . Before and after treatment , the mean H reflex latency and Hmax/Mmax ratio , right and left side were similar in the groups ( p > 0.05 ) , and no significant changes were observed in the treatment groups ( p > 0.05 ) . After treatment , the extension and lateral flexion range of motion significantly increased in the US group ( p = 0.04 ) , but the back movements in the placebo group did not show significant changes ( p > 0.05 ) . The present study supports the significant effect of US on LBP , and suggests that US may improve the functional ability of patients with non specific low back pain OBJECTIVE To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain ( LBP ) or neck pain ( NP ) according to their risk stratification , based on the Keele STarT ( Subgroup Targeted Treatment ) Back-Screening Tool ( SBT ) . DESIGN Prospect i ve cohort study with 3-month follow-up . SETTING Primary care . PARTICIPANTS General practitioners ( GPs ) and physiotherapists included patients ( N=284 ) with nonspecific LBP , NP , or both . INTERVENTIONS Patients completed a baseline question naire , including the Dutch SBT , for either LBP or NP . A follow-up measurement was conducted after 3 months to determine recovery ( using Global Perceived Effect Scale ) , pain ( using Numeric Pain Rating Scale ) , and function ( using Rol and Disability Question naire or Neck Disability Index ) . A question naire was sent to the GPs and physiotherapists to evaluate the provided treatment . MAIN OUTCOME MEASURES Prevalence of patients ' risk profile and clinicians ' applied care , and the percentage of patients with persisting disability at follow-up . A distinction was made between patients receiving the recommended treatment and those receiving the nonrecommended treatment . RESULTS In total , 12 GPs and 33 physiotherapists included patients . After 3 months , we analyzed 184 patients with LBP and 100 patients with NP . In the LBP group , 52.2 % of the patients were at low risk for persisting disability , 38.0 % were at medium risk , and 9.8 % were at high risk . Overall , 24.5 % of the patients with LBP received a low-risk treatment approach , 73.5 % a medium-risk , and 2.0 % a high-risk treatment approach . The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients ( 21.1 % and 10.0 % , respectively ) , and fair for medium-risk patients ( 51.4 % ) . In the NP group , 58.0 % of the patients were at low risk for persisting disability , 37.0 % were at medium risk , and 5.0 % were at high risk . Only 6.1 % of the patients with NP received the low-risk treatment approach . The medium-risk treatment approach was offered the most ( 90.8 % ) , and the high-risk approach was applied in only 3.1 % of the patients . The specific agreement between the risk profile and received treatment for patients with NP was poor for low-risk and medium-risk patients ( 6.3 % and 48.0 % , respectively ) ; agreement for high-risk patients could not be calculated . CONCLUSIONS Current Dutch primary care for patients with nonspecific LBP , NP , or both does not correspond to the recommended stratified-care approach based on the SBT , as most patients receive medium-risk treatment . Most low-risk patients are overtreated , and most high-risk patients are undertreated . Although the stratified-care approach has not yet been vali date d in Dutch primary care , these results indicate there may be substantial room for improvement Study Design . A prospect i ve repeated- measures design was applied . Objectives . To examine the measurement properties of the Back Pain Functional Scale ( BPFS ) and the Rol and –Morris Question naire ( RMQ )  and to formulate hypotheses and sample size estimates for a subsequent comparison study . Summary of Background Data . Although there are numerous functional status measures for patients with low back pain , most have been conceived of and vali date d with a group rather than an individual patient as the unit of interest . Also , little has been done to formally compare — this includes the generation of a priori hypotheses , followed by statistical hypotheses testing — the many competing measures . Methods . Subjects were 77 patients with low back pain who were referred by physicians to 10 outpatient physical therapy clinics located in Canada and the United States . The question naires were administered at patients ’ initial visits , within 48 hours of the initial visit , and at 1- , 2- , and 3-week follow-up visits . Reliability , cross-sectional validity , and longitudinal validity ( sensitivity to change ) coefficients were calculated . Results . Test – retest reliability estimates of 0.81 and 0.88 were obtained for the RMQ and BPFS , respectively . The measures demonstrated similar levels of cross-sectional validity . Correlations of 0.56 and 0.65 were noted between a prognostic rating of change and the RMQ and BPFS , respectively . The RMQ demonstrated a ceiling effect .  Approximately 180 patients are needed for a subsequent head-to-head comparison study of the measures . Conclusions . The BPFS appears to have sound measurement properties , and a formal head-to-head comparison study with the RMQ is warranted Study Design . Cross-cultural translation and psychometric testing were performed . Objectives . To cross-culturally translate the Oswestry Disability Index ( ODI ) , Rol and -Morris Disability Question naire ( RDQ ) , and Quebec Back Pain Disability Scale ( QDS ) into Persian , and then investigate the psychometric properties of the Persian versions produced . Summary of Background Data . To the authors ’ knowledge , there is no vali date d instrument to measure functional status in Persian-speaking patients with low back pain ( LBP ) in Iran . To our knowledge , the widely used back-specific measures , the ODI , RDQ , and QDS , have not been translated and vali date d for Persian-speaking patients with LBP . Methods . The translation and cross-cultural adaptation of the original question naires were performed in accordance with published guidelines . A total of 100 patients with chronic LBP were asked to complete a question naire booklet ( the Persian versions of the ODI , RDQ , QDS , Short Form Health Survey ( SF-36 ) , and visual analog scale measure of pain ) . There were 31 r and omly select patients with chronic LBP asked to complete the second question naire booklet 24 hours later . Results . The Cronbach-α for the ODI , RDQ , and QDS was 0.75 , 0.83 , and 0.92 , respectively . The ODI , RDQ , and QDS showed excellent test-retest reliability ( intraclass correlation coefficient = 0.91 , 0.86 , and 0.86 , respectively ) ( P < 0.01 ) . The correlation among the ODI , RDQ , QDS and physical functioning scales of the SF-36 was −0.66 , −0.62 , and −0.69 , respectively ( P < 0.001 ) . The correlation among the ODI , RDQ , and QDS and visual analog scale was 0.54 , 0.36 , and 0.46 , respectively ( P < 0.001 ) . Conclusions . The Persian versions of the ODI , RDQ , and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales , and the use of them can be recommended in a clinical setting and future outcome studies in Iran Study Design . The Oswestry Disability Index v2.0 ( ODI ) , SF36 Physical Function Domain ( SF-36 PFD ) , and PROMIS Physical Function CAT v1.2 ( PF CAT ) question naires were prospect ively collected from 1607 patients complaining of back or leg pain , visiting a university-based spine clinic . All question naires were collected electronically , using a tablet computer . Objective . The aim of this study was to compare the psychometric properties of the PROMIS PF CAT with the ODI and SF36 Physical Function Domain in the same patient population . Summary of Background Data . Evidence -based decision-making is improved by using high- quality patient-reported outcomes measures . Prior studies have revealed the shortcomings of the ODI and SF36 , commonly used in spine patients . The PROMIS Network has developed measures with excellent psychometric properties . The Physical Function domain , delivered by Computerized Adaptive Testing ( PF CAT ) , performs well in the spine patient population , though to- date direct comparisons with common measures have not been performed . Methods . St and ard Rasch analysis was performed to directly compare the psychometrics of the PF CAT , ODI , and SF36 PFD . Spearman correlations were computed to examine the correlations of the three instruments . Time required for administration was also recorded . Results . One thous and six hundred seven patients were administered all assessment s. The time required to answer all items in the PF CAT , ODI , and SF-36 PFD was 44 , 169 , and 99 seconds . The ceiling and floor effects were excellent for the PF CAT ( 0.81 % , 3.86 % ) , while the ceiling effects were marginal and floor effects quite poor for the ODI ( 6.91 % and 44.24 % ) and SF-36 PFD ( 5.97 % and 23.65 % ) . All instruments significantly correlated with each other . Conclusion . The PROMIS PF CAT outperforms the ODI and SF-36 PFD in the spine patient population and is highly correlated . It has better coverage , while taking less time to administer with fewer questions to answer . Level of Evidence : BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing Study Design . A cross-sectional study was conducted to analyze a convenience sample of patients seeking treatment for cervical spine conditions . Objective . To develop and evaluate the psychometric properties of a comprehensive , disease-specific question naire for characterizing complaints of neck pain and evaluating the outcomes of treatments for these complaints . Summary of Background Data . There currently are a number of generic and disease-specific instruments for assessing complaints of neck pain . None comprehensively cover the wide range of factors considered essential in evaluating treatment outcomes . Methods . The authors developed a comprehensive , disease-specific question naire for characterizing complaints of neck pain and evaluating the outcomes of treatments for these complaints . In this study , 216 patients who underwent surgery for cervical spine disorders completed the Cervical Spine Outcomes Question naire before treatment , then at 3 and 6 months after treatment . The data were used to evaluate the reliability , validity , and responsiveness of the question naire . Results . The authors have shown that the Cervical Spine Outcomes Question naire has high test – retest reliability , good construct validity , and responsiveness to change after treatment . Conclusions . The Cervical Spine Outcomes Question naire is a comprehensive , disease-specific instrument for assessing complaints of neck pain and evaluating the outcomes of treatments for these complaints . It provides information on demographics , pain severity , functional disability , psychological distress , physical symptoms , health care utilization , and satisfaction . It appears to be acceptable to patients , easy to administer , highly reliable , valid , and responsive . It should be considered for use in monitoring patients with cervical spine conditions and in studies of cervical spine disorders and their treatments & NA ; Few studies have directly compared the clinical features of neuropathic and non‐neuropathic pains . For this purpose , the French Neuropathic Pain Group developed a clinician‐administered question naire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination . This question naire was used in a prospect i ve study of 160 patients presenting with pain associated with a definite neurological or somatic lesion . The most common aetiologies of nervous lesions ( n=89 ) were traumatic nerve injury , post herpetic neuralgia and post stroke pain . Non‐neurological lesions ( n=71 ) were represented by osteoarthritis , inflammatory arthropathies and mechanical low back pain . Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non‐neuropathic pain . The prevalence of pain descriptors and sensory dysfunctions were systematic ally compared in the two groups of patients . The analysis of the psychometric properties of the DN4 question naire included : face validity , inter‐rater reliability , factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain . We found that a relatively small number of items are sufficient to discriminate neuropathic pain . The 10‐item question naire developed in the present study constitutes a new diagnostic instrument , which might be helpful both in clinical research and daily practice Study Design . Pragmatic , multicentered r and omized controlled trial , with 12-month follow-up . Objective . To evaluate the effect of adding specific spinal stabilization exercises to conventional physiotherapy for patients with recurrent low back pain ( LBP ) in the United Kingdom . Summary of Background Data . Spinal stabilization exercises are a popular form of physiotherapy management for LBP , and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result . Methods . A total of 97 patients ( 18–60 years old ) with recurrent LBP were recruited . Stratified r and omization was undertaken into 2 groups : “ conventional , ” physiotherapy consisting of general active exercise and manual therapy ; and conventional physiotherapy plus specific spinal stabilization exercises . Stratifying variables used were laterality of symptoms , duration of symptoms , and Rol and Morris Disability Question naire score at baseline . Both groups received The Back Book , by Rol and et al. Back-specific functional disability ( Rol and Morris Disability Question naire ) at 12 months was the primary outcome . Pain , quality of life , and psychologic measures were also collected at 6 and 12 months . Analysis was by intention to treat . Results . A total of 68 patients ( 70 % ) provided 12-month follow-up data . Both groups showed improved physical functioning , reduced pain intensity , and an improvement in the physical component of quality of life . Mean change in physical functioning , measured by the Rol and Morris Disability Question naire , was −5.1 ( 95 % confidence interval −6.3 to −3.9 ) for the specific spinal stabilization exercises group and −5.4 ( 95 % confidence interval −6.5 to −4.2 ) for the conventional physiotherapy group . No statistically significant differences between the 2 groups were shown for any of the outcomes measured , at any time . Conclusions . Patients with LBP had improvement with both treatment packages to a similar degree . There was no additional benefit of adding specific spinal stabilization exercises to a conventional physiotherapy package for patients with recurrent LBP & NA ; Electronic question naires for pain assessment are becoming increasingly popular . There have been no published reports to establish the equivalence or psychometric properties of common pain question naires administered via desktop computers . This study compared responses to paper ( P ) and touch screen electronic ( E ) versions of the Short‐Form McGill Pain Question naire ( SF‐MPQ ) and Pain Disability Index ( PDI ) , while examining the role of computer anxiety and experience , and evaluating patient acceptance . In a r and omized , crossover design 189 chronic pain patients completed P and E versions of the SF‐MPQ and PDI , and self‐ratings of anxiety , experience , relative ease and preference . Psychometric properties were highly similar for P and E question naires . For the SF‐MPQ , 60 % or more of subjects gave equivalent responses on individual descriptors and PPI scale , with 80 % rating within ±1 point for an 11‐point VAS . Correlations for the SF‐MPQ scales ranged from 0.68 to 0.84 . For the PDI , 60 % or more of subjects responded within ±1 point on individual questions , and the total score correlation was 0.67 . Comparison of mean difference scores revealed no significant differences between modes for any of the question naire items or scores . Anxiety and experience scores showed no significant associations through correlations and high/low comparisons . Although nearly half of subjects reported no computer training , anxiety ratings were low , and considerably more subjects rated the E question naires as easier and preferred . Findings are consistent with test‐retest reliability data , and support the validity and acceptance of electronic versions of the SF‐MPQ and PDI OBJECTIVE To develop a condition-specific quality of life question naire for the menopause with documented psychometric properties , based on women 's experience . METHODS SUBJECTS Women 2 - 7 years post-menopause with a uterus and not currently on hormone replacement therapy . Question naire development : A list of 106 menopause symptoms was reduced using the importance score method . Replies to the item-reduction question naire from 88 women result ed in a 30-item question naire with four domains , vasomotor , physical , psychosocial and sexual , and a global quality of life question . Psychometric properties : A separate sample of 20 women was used to determine face validity , and a panel of experts was used to confirm content validity . Reliability , responsiveness and construct validity were determined within the context of a r and omized controlled trial . Construct validation involved comparison with the Neugarten and Kraines'Somatic , Psychosomatic and Psychologic subscales , the reported intensity of hot flushes , the General Well-Being Schedule , Channon and Ballinger 's Vaginal Symptoms Score and Libido Index , and the Life Satisfaction Index . RESULTS The face validity score was 4.7 out of a possible 5 . Content validity was confirmed . Test-retest reliability measures , using intraclass correlation coefficients were 0.81 , 0.79 , 0.70 and 0.55 for the physical , psychosocial , sexual domains and the quality of life question . The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change . Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain , 0.66 and 0.40 for the vasomotor domain , 0.65 and -0.71 for the psychosocial domain , 0.48 and 0.38 for the sexual domain , and 0.57 for the quality of life question . Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain , 0.28 for the vasomotor domain , 0.55 and -0.54 for the psychosocial domain , 0.54 and 0.32 for the sexual domain , and 0.12 for the quality of life question . Responsiveness scores ranged from 0.78 to 1.34 . CONCLUSIONS The MENQOL ( Menopause-Specific Quality of Life ) question naire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life Objectives Question naires are essential for measuring tinnitus severity and intervention-related change but there is no st and ard instrument used routinely in research setting s. Most tinnitus question naires are optimised for measuring severity but not change . However , the Tinnitus Functional Index ( TFI ) cl aims to be optimised for both . It has not however been fully vali date d for research purpose s. Here we evaluate the relevant psychometric properties of the TFI , specifically the question naire factor structure , reproducibility , validity and responsiveness guided by quality criteria for the measurement properties of health-related question naires . Methods The study involved a retrospective analysis of data collected for 294 members of the general public who participated in a r and omised controlled trial of a novel tinnitus device ( Clinical Trials.gov Identifier : NCT01541969 ) . Participants completed up to eight commonly used assessment question naires including the TFI , Tinnitus H and icap Inventory ( THI ) , Tinnitus H and icap Question naire ( THQ ) , a Visual Analogue Scale of loudness ( VAS-Loudness ) , Percentage Annoyance question , the Beck 's Depression Inventory ( BDI ) , Beck 's Anxiety Inventory ( BAI ) , and the World Health Organisation Quality of Life-Bref ( WHOQOL-BREF ) . A series of analyses assessed the study objectives . Forty four participants completed the TFI at a second visit ( within 7–21 days and before receiving any intervention ) providing data for reproducibility assessment s. Results The 8-factor structure was not fully confirmed for this general ( non- clinical ) population . Whilst it was acceptable st and alone subscale , the ‘ auditory ’ factor showed poor loading with the higher order factor ‘ functional impact of tinnitus ’ . Reproducibility assessment s for the overall TFI indicate high internal consistency ( α = 0.80 ) and extremely high reliability ( ICC : 0.91 ) , whilst agreement was borderline acceptable ( 93 % ) . Construct validity was demonstrated by high correlations between scores on the TFI and THI ( r = 0.82 ) and THQ ( r = 0.82 ) , moderate correlations with VAS-L ( r = 0.46 ) , PR-A ( r = 0.58 ) , BDI ( r = 0.57 ) , BAI ( r = 0.39 ) and WHOQOL ( r = −0.48 ) . Floor effects were observed for more than 50 % of the items . A smallest detectable change score of 22.4 is proposed for the TFI global score . Conclusion Even though the proposed 8-factor structure was not fully confirmed for this population , the TFI appears to cover multiple symptom domains , and to measure the construct of tinnitus with an excellent reliability in distinguishing between patients . While the TFI may discriminate those whose tinnitus is not a problem , floor effects in many items means it is less appropriate as a measure of change in this subgroup . Further investigation is needed to determine whether these effects are relevant in other population Self question naires are an important aspect of the management of neck pain patients . The Bournemouth Question naire ( BQ ) , based on the biopsychosocial model , is design ed to evaluate patients with neck pain . The vali date d English version of this question naire ( BQc-English ) has psychometric properties that range from moderate to excellent . The goal of this study is to translate and vali date a French version of the Bournemouth Question naire for neck pain patients ( BQc-f ) . Its translation and adaptation are performed using the translation back-translation method , generating a consensus among the translators . This validation study was performed on 68 subjects ( mean age 41 years old ) who participated in a r and omized controlled trial regarding the efficiency of manual therapy for neck pain patients . This experimental protocol was design ed to generate data in order to evaluate the construct validity , longitudinal validity , test-retest reliability and responsiveness . The BQc-f psychometric properties of construct validity ( r = 0.67 , 0.61 , 0.42 ) for pre treatment , post treatment and longitudinal validity , respectively ) , test-retest reliability ( r = 0.97 ) and responsiveness ( effect size = 0.56 and mean st and ardized response = 0.61 ) are sufficient to suggest it could be used in the management of patients with neck pain The purpose of this prospect i ve , single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale ( NRS ) , Rol and –Morris disability question naire ( RMDQ ) , Oswestry disability index ( ODI ) , pain self-efficacy question naire ( PSEQ ) and the patient-specific functional scale ( PSFS ) in order to determine which would best measure clinical ly meaningful change in a chronic low back pain ( LBP ) population . Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population . However , there is a lack of consensus on what constitutes a “ successful ” outcome , how an important improvement/deterioration has been defined and which outcome measure(s ) best captures the effectiveness of therapeutic interventions for the chronic LBP population . Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study ; 48 of the 63 patients had complete data . Five question naires were administered initially and after the 5-week back class intervention . Also at 5 weeks , patients completed a global impression of change as a reflection of meaningful change in patient status . Score changes in the five different question naires were subjected to both distribution- and anchor-based methods : st and ard error of measurement ( SEM ) and receiver operating characteristic ( ROC ) curves to define clinical improvement . From these methods , the minimal clinical ly important difference ( MCID ) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument . Based on the SEM , a point score change of 2.4 in the NRS , 5 in the RMDQ , 17 in the ODI , 11 on the PSEQ , and 1.4 on the PSFS corresponded to the MCID . Based on ROC curve analysis , a point score change of 4 points for both the NRS and RMDQ , 8 points for the ODI , 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID . The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinical ly important change over time . The NRS was found to be least responsive . The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change . Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme . However , due to the small sample size , the lack of observed worsening of symptoms over time , the single centre and intervention studied these results which need to be interpreted with caution Background Activity advice and prescription are commonly used in the management of low back pain ( LBP ) . Although there is evidence for advising patients with LBP to remain active , facilitating both recovery and return to work , to date no research has assessed whether objective measurements of free living physical activity ( PA ) can predict outcome , recovery and course of LBP . Methods An observational longitudinal study will investigate  PA  levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP . Each participant 's  PA level , functional status , mood , fear avoidance behaviours , and levels of pain , psychological distress and occupational activity  will be measured on three occasions during for 1 week periods at baseline , 3 months , and 1 year .  Physical activity levels  will be measured by self report , RT3 triaxial accelerometer , and activity recall question naires . The primary outcome measure of functional recovery will be the Rol and Morris Disability Question naire ( RMDQ ) . Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population . Discussion This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery . The results will assess whether occupational , psychological and behavioural factors affect the relationship between free living PA and LBP recovery . Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.Trial registration [ Clinical Trial Registration Number , ACTRN12609000282280 Background Low back pain ( LBP ) and neck pain ( NP ) are common among workers .  Participatory Ergonomics ( PE ) is used as an implementation strategy to prevent these symptoms . By following the steps of PE , working groups composed and prioritised ergonomic measures , and developed an implementation plan . Working group members were responsible to implement the ergonomic measures in their departments . Little is known about factors that hamper ( barriers ) or enhance ( facilitators ) the implementation of ergonomic measures . This study aim ed to identify and underst and the possible barriers and facilitators that were perceived during implementation . Methods This study is embedded in a cluster r and omised controlled trial that investigated the effectiveness of PE to prevent LBP and NP among workers . For the purpose of the current study , question naires were sent to 81 working group members . Their answers were used to make a first inventory of possible barriers and facilitators to implementation . Based on the question naire information , 15 semi-structured interviews were held to explore the barriers and facilitators in more detail . All interviews were audio taped , transcribed verbatim , and analysed according to a systematic approach . Results All possible barriers and facilitators were obtained from question naire data , indicating that the semi-structured interviews did not yield information about new factors . Various barriers and facilitators were experienced . The presence of implementation plans for ergonomic measures  that were already approved by the management facilitated implementation before the working group meeting . In these cases , PE served as a strategy to improve the implementation of the approved measures . Furthermore , the findings showed that the composition of a working group ( i.e. , including decision makers and a worker who led the implementation process ) was important . Moreover , stakeholder involvement and collaboration were reported to considerably improve implementation . Conclusions This study showed that the working group as well as stakeholder involvement and collaboration were important facilitating factors . Moreover , PE was used as a strategy to improve the implementation of existing ergonomic measures . The results can be used to improve PE programmes , and thereby may contribute to the prevention of LBP and NP.Trial registration numberIS RCT AIM The aim of this study was to investigate the effect of continuous ultrasound ( US ) plus exercise on the endurance of paravertebral muscles of patients with chronic non specific low back pain ( CNSLBP ) . METHODS AND MATERIAL S In this pilot , pretest-posttest study , 22 patients with CNSLBP participated . Patients received 10 sessions of treatment , including continuous US plus exercise therapy , over a period of four consecutive weeks . Median frequency slopes of Iliocostalis and Multifidus muscles as well as holding time during Biering-Sorensen test were measured using surface electromyography . In addition , function and pain were measured using Functional Rating Index ( FRI ) question naire and VAS . RESULTS Five females and 15 males with a mean age of 31.7 years completed the treatment . Descriptive data showed a decrease of 0.01 and 0.02 mean in median frequency slope of right and left Iliocostalis respectively and a mean of 0.08 decrease for both right and left Multifidus muscles . Endurance time increased 1.8 seconds mean . Both function ( 17 % ) and pain ( 24 % ) improved post treatment . CONCLUSION Larger population studies in the context of high quality , r and omized clinical trial are needed to vali date the results Study Design . Validation of 2 self-report question naires . Objective . To evaluate the internal consistency , reliability , and construct validity of the Persian versions of the fear avoidance beliefs question naire ( FABQ ) and the Tampa Scale of Kinesiophobia ( TSK ) in patients with acute and chronic neck pain . Summary of Background Data . The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain . To date , the psychometric properties of these question naires have not been demonstrated in Persian-speaking patients with neck pain in Iran . Methods . One hundred sixty-six patients with acute and chronic neck pain participated in the study . The construct validity of the question naires was evaluated by measuring convergent and known-groups validity . The visual analogue scale measure of pain , neck disability index , hospital anxiety and depression scale , and the physical ( PCS-12 ) and mental ( MCS-12 ) summary scores of the Short Form health survey ( SF-12 ) were used to test construct validity of the Persian FABQ and TSK . In addition , 50 r and omly selected patients with chronic neck pain were asked to complete the question naires 48 hours later for the second time . Results . Cronbach & agr ; coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78 , respectively . The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80 . There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index ( r = 0.44–0.55 ) , Depression subscales of the hospital anxiety and depression scale ( r = 0.42–0.48 ) , and PCS-12 ( r = −0.34 to −0.62 ) . Conclusion . The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain . However , considering the study limitations , the findings should be interpreted with caution . Level of Evidence : Background The need for cost effectiveness analyses in r and omized controlled trials that compare treatment options is increasing . The selection of the optimal utility measure is important , and a central question is whether the two most commonly used indexes - the EuroQuol 5D ( EQ5D ) and the Short Form 6D ( SF6D ) – can be used interchangeably . The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties . The psychometric properties of the two utility indexes were compared to a disease-specific instrument , the Oswestry Disability Index ( ODI ) , in the setting of a r and omized controlled trial for degenerative disc disease . Methods In a r and omized controlled multicentre trial , 172 patients who had experienced low back pain for an average of 6 years were r and omized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses .  Patients filled out the ODI , EQ5D , and SF-36 at baseline and two-year follow up . The utility indexes was compared with respect to measurement error , structural validity , criterion validity , responsiveness , and interpretability according to the COSMIN taxonomy . Results At follow up , 113 patients had change score values  for all three instruments . The SF6D had better similarity with the disease-specific instrument ( ODI ) regarding sensitivity , specificity , and responsiveness . Measurement error was lower for the SF6D ( 0.056 ) compared to the EQ5D ( 0.155 ) . The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D . The minimal detectable change score value at a 95 % confidence level were 0.157 for SF6D and 0.429 for EQ5D , and the difference in mean change score values ( SD ) between them was 0.23 ( 0.29 ) and so exceeded the clinical significant change score value for both instruments . Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately , but that they do not exactly measure the same underlying construct . Conclusions This study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable . Since the similarity with the “ gold st and ard ” ( the disease-specific instrument ) was quite different , this could indicate that the choice of index should be determined by the diagnosis
Our findings show strong positive evidence for structural validity and internal consistency in patients with SP and LBP .
The current evidence shows that the FRI is comparable with both the Oswestry Disability Index and the Neck Disability Index in responsiveness .
To assess the measurement properties of the Functional Rating Index ( FRI ) and determine whether its measurement properties are comparable with other region-specific question naires .
In addition to low back pain ( LBP ) and neck pain ( NP ) , multiregion spinal pain ( SP ) is a common problem with a considerable prevalence in the general population .
The FRI was built to assess physical functioning in patients with SP .
However , a systematic review assessing evidence of its measurement properties in separated population s and a comparison with other question naires regarding each measurement property is lacking .