Function and the patient with chronic low back pain. Level of Distress in a Recurrent Low Back Pain Population Referred for Physical Therapy Treatment of low back pain by acupressure and physical therapy: randomised controlled trial The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Assessing Activity Limitations and Symptoms in People With Pelvic Girdle Pain The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain Responsiveness of common outcome measures for patients with low back pain. Early Physician Notification of Patient Disability Risk and Clinical Guidelines After Low Back Injury: A Randomized, Controlled Trial A within-subjects trial to test the equivalence of online and paper outcome measures: the Roland Morris Disability Questionnaire Symptoms, signs, and functional disability in adult spondylolisthesis. Rasch Analysis of the Roland Disability Questionnaire Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain Functional Restoration for Chronic Low Back Pain: Two‐Year Follow‐Up of Two Randomized Clinical Trials Physical Therapy Treatment of Back Complaints on Children and Adolescents Health-related quality of life in patients with advanced prostate cancer: A multinational perspective Components of Initial and Residual Disability After Back Injury in Nurses Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble Is Work Status of Low Back Pain Patients Best Described by an Automated Device or by a Questionnaire? The Effects of Therapeutic Climbing in Patients with Chronic Low Back Pain: A Randomized Controlled Study French validation of the Foot Function Index (FFI).
OBJECTIVE To undertake a comparative examination of the reliability and validity of two frequently used self-report measures of functional disability , the Pain Disability Index  ( PDI ) and the Oswestry Low Back Pain Disability Question naire  ( OLBPDQ ) . DESIGN A descriptive ex-post facto design was used in the study . SETTING Pain clinics and neurosurgical units at three metropolitan hospitals . SUBJECTS One hundred patients with chronic low back pain of noncancer origin were administered the two question naires as part of a larger question naire battery . RESULTS Acceptable internal consistency values of 0.76 for the PDI and 0.71 for the OLBPDQ were obtained . A correlation of r = 0.63 was found between the PDI and the OLBPDQ , supporting the concurrent validity of the two scales . Both the scales were found to be correlated to the Beck Depression Inventory scores ( PDI , r = 0.42 ; OLBPDQ , r = 0.39 ) , with higher disability associated with greater depression . Only the total PDI score was found to be sensitive to functional status differences within the patient sample . CONCLUSIONS These findings support other recent work in favor of the PDI . The PDI had a slightly higher internal consistency and was more sensitive than the OLBPDQ Study Design . Recruitment phase of a r and omized clinical trial . Objectives . To review the published literature on the use of the  distress risk assessment method in different back pain population s and healthcare setting s and compare results with those obtained from the current trial . Summary of Background . Psychological distress in low back pain is commonplace , and distress increases the relative risk of poor outcome with physical treatment alone . The  Distress and Risk Assessment Method  is a tool for use in the clinical setting to assist in the identification of distress and clinical decision-making . Methods . The  Distress Risk Assessment Method and Rol and Morris Disability Question naire were used to assess eligibility of patients with recurrent low back pain for recruitment into a r and omized clinical trial examining different physical therapy approaches . Results . In total , 221 patients were assessed , result ing in 212 correctly complete question naires . Of those 212 , 71 ( 33 % ) showed evidence of marked distress ( 41 depressed and 30 somatic ) . Functional disability , measured using the Rol and Morris Disability Question naire , was higher for the distressed group ( mean 14.1 , SD 4.8 , range 3–23 ) than the nondistressed group ( mean 8.0 , SD 5.1 , range 0–21 ) . Distress and anxiety measured using the distress risk assessment method were correlated to self-reported back-related functional disability . Conclusions . Distress associated with low back pain is common with one third of patients referred for physical therapy at the units studied exhibiting a level of distress that increased their relative risk of poor outcome by 3 to 4 times . Clinical ly , screening this group of patients may help indicate when liaison with other professionals is appropriate and possibly identify those patients who may be too distressed to respond to physical therapy intervention alone Abstract Objective To evaluate the effectiveness of acupressure in terms of disability , pain scores , and functional status . Design R and omised controlled trial . Setting Orthopaedic clinic in Kaohsiung , Taiwan . Participants 129 patients with chronic low back pain . Intervention Acupressure or physical therapy for one month . Main outcome measures Self administered Chinese versions of st and ard outcome measures for low back pain ( primary outcome : Rol and and Morris disability question naire ) at baseline , after treatment , and at six month follow-up . Results The mean total Rol and and Morris disability question naire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score ( - 3.8 , 95 % confidence interval - 5.7 to - 1.9 ) or mean change from the baseline ( - 4.64 , - 6.39 to - 2.89 ) . Acupressure conferred an 89 % ( 95 % confidence interval 61 % to 97 % ) reduction in significant disability compared with physical therapy . The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up . Statistically significant differences also occurred between the two groups for all six domains of the core outcome , pain visual scale , and modified Oswestry disability question naire after treatment and at six month follow-up . Conclusions Acupressure was effective in reducing low back pain in terms of disability , pain scores , and functional status . The benefit was sustained for six months Background No appropriate measures have been specifically developed for pelvic girdle pain ( PGP ) . There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice . Objective The objective of this study was to develop a condition-specific measure , the Pelvic Girdle Question naire ( PGQ ) , for use during pregnancy and postpartum . Design This was a methodology study . Methods Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP .  Face validity and content validity were assessed by classifying the items according to the World Health Organization 's International Classification of Functioning , Disability and Health . After a pilot study , the PGQ was administered to participants with clinical ly verified PGP by means of a postal question naire in 2 surveys . The first survey included 94 participants ( 52 pregnant ) , and the second survey included 87 participants ( 43 pregnant ) . Rasch analysis was used for item reduction , and the PGQ was assessed for unidimensionality , item fit , redundancy , and differential item functioning . Test-retest reliability was assessed with a r and om sample of 42 participants . Results The analysis result ed in a question naire consisting of 20 activity items and 5 symptom items on a 4-point response scale . The items in both subscales showed a good fit to the Rasch model , with acceptable internal consistency , satisfactory fit residuals , and no disordered threshold . Test-retest reliability showed high intraclass correlation coefficient estimates : .93 ( 95 % confidence interval=0.86–0.96 ) for the PGQ activity subscale and .91 ( 95 % confidence interval=0.84–0.95 ) for the PGQ symptom subscale . Limitations The PGQ should be compared with low back pain question naires as part of a concurrent evaluation of measurement properties , including validity and responsiveness to change . Conclusions The PGQ is the first condition-specific measure developed for people with PGP . The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum , it is simple to administer , and it is feasible for use in clinical practice 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 Pain Management Programmes ( PMPs ) are a multi-disciplinary approach to the management of chronic low back pain ( CLBP ) . Notwithst and ing evidence of effectiveness , successful take-up of programmes requires acceptability to patients . We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care . Specifically , we estimated the probability of uptake of alternative configurations of PMPs . Potential attributes and associated levels influencing take-up were identified through a systematic literature review , survey of current PMPs , expert consultation , and focus groups . Five attributes were included : content ; provider ; schedule ; group size ; and travel time to clinic . Four hundred and fourteen question naires were mailed to patients attending clinics and 124 question naires were returned suitable for analysis . Method of delivery influenced probability of take-up , with small group sizes and low intensity programmes over a prolonged period increasing the probabilities . Travel time was also important . However , providers and contents of PMPs were not main drivers of preferences , though those with more severe pain did prefer PMPs provided by more specialists . Probability of take-up increases when PMPs better reflect patient preferences . Given preferences , re source constraints , and evidence on clinical outcomes of alternative configurations it is suggested more re source -intensive PMPs be reserved for those with the most severe and disabling pain and less intensive programmes delivered over a longer time period in smaller groups for those with less severe pain . These findings can inform future r and omised trials to evaluate acceptable PMPs in primary care OBJECTIVE To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain . DESIGN A r and omized controlled trial . PATIENTS A total of 146 patients with chronic low back pain were enrolled in the study . METHODS Subjects were divided into 2 groups : the back school group received exercise , physical treatment modalities and a back school programme ; and the control group received exercise and physical treatment modalities .  Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment , in terms of pain , measured with the Visual Analogue Scale , and functional status , measured with the Oswestry Low Back Pain Disability Question naire . RESULTS In both groups , Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire were significantly reduced after therapy ( p < 0.01 ) , but the difference between the scores at the end of treatment and 3 months post-treatment was not significant . There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire in the back school group compared with the control group at the end of therapy and 3 months post-treatment ( p < 0.05 ) . CONCLUSION The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) ,  Oswestry Disability Index ( ODI ) ,  Disability Rating Index ( DRI ) , and  Physical Functioning scale of the SF-36 ( PFSF-36 ) , and two  pain scales , a  Numerical Pain Rating Scale ( NRS ) and  Visual Analogue Scale ( VAS ) .  Summary of Background Data . Concurrent comparisons of different outcome measurements in back patients have been requested . Methods .  Norwegian versions of the scales and question naires  were completed by 54 patients with acute ( < 3weeks ) and 50 patients with chronic low back pain ( > 3 months ) . Clinical change was estimated on a global change index . An alternative external criterion was the expected clinical course in the two cohorts . Mean changes , st and ardized response mean ( SRM ) , and area under the receiver operating characteristic ( ROC ) curves with cutoff point for highest sensitivity and specificity were calculated . Results . At the follow-up , 63 % of the acute and 41 % of the chronic sample reported improvement on the global change index . Large SRMs ( 1.3–2.0 ) and areas under the ROC curves ( 0.84–0.93 ) were found for the measurements in the acute sample . In the chronic sample , the SRMs ( 0.4–1.1 ) and areas under the ROC curves ( 0.65–0.83 ) were lower , in particular for the PFSF-36 and the VAS . There was no statistically significant difference between the responsiveness in the measurements , except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change . Conclusion . The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain , whereas among chronic patients the RMDQ , ODI , DRI , and NRS were most appropriate STUDY DESIGN A prospect i ve cohort study assessing the responsiveness of two disease-specific question naires and a generic health question naire for patients with low back pain and sciatica . OBJECTIVES To compare the responsiveness of the eight scales and two summery scales of the SF-36 question naire with that of the Oswestry Disability Index and Low Back Outcome Score question naires . SUMMARY OF BACKGROUND DATA Evaluation of treatment outcome is being determined more frequently from a patient 's perspective , particularly the impact treatment has on current health status . METHODS Patients were recruited from two orthopedic back pain clinics in a tertiary hospital . Patients completed the pretreatment question naire 1 month before treatment and follow-up question naires a minimum of 2 - 6 months after treatment . Patients undergoing surgery were also observed for a minimum of 2 years . RESULTS Overall , the Oswestry Disability Index was most responsive ; however , individual scales from the SF-36 question naire showed equal or greater sensitivity to change than the Oswestry Disability Index in each of the patient subgroups . The SF-36 Role Physical scale was prone to floor effects ( a high percentage of respondents score zero ) , and the change scores from the SF-36 Role Emotional scale varied by 100 points in either direction in each of the patient subgroups . CONCLUSION Responsiveness varied according to which method was used in its calculation . The responsiveness of the SF-36 question naire shows that it can be a useful adjunct in the assessment of patients with low back pain when combined with disease-specific question naires Study Design . Back‐injured workers with high disability risk scores on a predictive question naire participated in a r and omized , controlled trial of physician notification , with outcomes follow‐up 3 months after injury . Objectives . To test whether physician intervention improves return to work and self‐ assessment outcomes for people at relatively high risk for disability . Summary of Background Data . Only a small number of back‐injured workers suffer significant disability . Ouick identification of these people would facilitate more efficient targeting and trials of interventions . Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability . Methods . Workers filing back injury reports responded to a disability prediction question naire . Those with high risk scores were r and omly assigned to control or intervention groups . Patient‐ design ated physicians in the intervention group received two letters identifying the patient 's risk and making recommendations for care , including the Agency for Health Care Policy and Research 's algorithms for acute low back pain . Predictive accuracy of the question naire and efficacy of physician intervention were evaluated on the basis of work status and self‐ assessment s 3 months after injury . Results . Of the 268 workers completing the question naire portion of the study , 32 ( 12 % ) were out of work because of back pain 3 months after injury . The question naire 's predictive accuracy included maximum κ of 0.277 and a receiver operating curve area of 0.78 . Fifty‐three people completed the physician intervention trial . The intervention had no significant impact on return to work , self‐assessed pain , or satisfaction with health care . Conclusions . Stratification of back‐injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not . The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future Background Augmenting vali date d paper versions of existing outcome measures with an equivalent online version may offer substantial research advantages ( cost , rapidity and reliability ) . However , equivalence of online and paper question naires can not be assumed , nor can acceptability to respondents . The aim was to test whether online and written versions of the Rol and Morris Disability Question naire  ( RMDQ ) , a st and ard measure of functional disability in back pain , are equivalent at both group and individual levels to establish whether they can be used interchangeably . Methods This is a within- participants equivalence study . 167 participants with back pain fully completed both the paper and online versions of the RMDQ  in r and om order . Participants were recruited from a chiropractic clinic and patient support groups in Southern Engl and . Limits of equivalence were pre-defined as 0.5 RMDQ points , the Bl and -Altman range was calculated , and participants ' comments were examined using content analysis . Results The mean score difference was 0.03 ( SD = 1.43 ) , with the 95 % Confidence Interval falling entirely within our limits of equivalence ( -0.19 to 0.25 ) . The Bl and -Altman range was -2.77 to 2.83 RMDQ points . Participants identified unique advantages and disadvantages associated with each version of the RMDQ . Conclusions The group and individual level data suggest that online and paper versions of the RMDQ are equivalent and can be used interchangeably . The Bl and -Altman range appears to reflect the known measurement properties of the RMDQ . Furthermore , participants ' comments confirmed the potential value to be had from offering them the choice of completing the RMDQ online or on paper STUDY DESIGN A cross-sectional clinical study . OBJECTIVES To determine whether there are specific symptoms , signs , and functional disability associated with adult spondylolisthesis . SUMMARY OF BACKGROUND DATA In spite of the common occurrence of adult spondylolisthesis , the symptoms , signs , and disability associated with it have not been analyzed in a large , well-defined group of patients . METHODS The symptoms , signs , and disability of 111 consecutive patients with adult spondylolisthesis , before r and omized treatment with fusion or physiotherapy  , were compared with those of 39 patients with nonspecific low back pain before lumbar fusion .  The patients completed a question naire covering clinical history and symptoms and su bmi tted a pain drawing . The signs were documented . Functional disability and pain were quantified by 12-function and 2-pain visual analog scales , respectively . RESULTS Sixty-two percent of the patients reported low back pain as well as sciatica , 7 % sciatica only , and 31 % low back pain only . Specific signs were infrequent . A positive straight leg raising test result in 12 % and an L5 sensory disturbance in 13 % were the most common . The symptoms were similar in patients with spondylolisthesis and chronic low back pain , but the chronic low back pain group reported more functional disability . Patients with a nonorganic pain drawing ( widespread , nonspecific pain ) were more often blue collar workers ; were more often and longer on sick leave ; and reported reduced mental condition , sexual function , functional ability , and more pain than patients with an organic pain drawing ( localized , specific pain ) . CONCLUSIONS The clinical pattern and functional disability in adult spondylolisthesis and in low back pain of nonspecific origin are similar . Sciatica in adult spondylolisthesis is typically not associated with a positive straight leg raising test result Study Design . A cross-sectional survey using  patient question naires  was conducted . Objective . To assess whether the Rol and Disability Question naire satisfies the Rasch model including unidimensionality and item separation . Summary of Background Data . The Rol and Disability Question naire , the most widely used patient-assessed measure of health outcome for back pain , has undergone several evaluations for its measurement properties including reliability , validity , and responsiveness . However , there is no published work relating to the underlying dimensionality of the instrument and the extent to which individual items contribute to the construct of physical disability result ing from low back pain . Methods . Patients entering a r and omized controlled trial of exercise , manipulation , and usual management for back pain completed a question naire that included the Rol and Disability Question naire . The Winsteps program was used to assess whether the Rol and Disability Question naire fits the Rasch model . Item fit was assessed using the Infit and Outfit statistics . Results . The  Rol and Disability Question  naire was completed by 1008 ( 90 % ) of the patients taking part in the trial . Most of the items in the Rol and Disability Question naire contribute to a single underlying construct . However , four items had poor Outfit statistics , suggesting that they do not contribute sufficiently to the scale hierarchy . Several items positioned around the middle of the hierarchy are not sufficiently distinct in terms of difficulty . There were very few items positioned at the extremes of the hierarchy . Conclusions . The Rol and Disability Question naire largely satisfies the Rasch model for unidimensionality . However , the instrument could be improved through the removal of poorly fitting items and the addition of items at the upper and lower points of the scale hierarchy . The distribution of Rol and Disability Question naire scores should be carefully considered before statistical testing is undertaken . Rasch transformed scores can be used to deal with deficiencies in the scale hierarchy Study Design . The effectiveness and efficacy of Iyengar yoga for chronic low back pain ( CLBP ) were assessed with intention-to-treat and per- protocol analysis . Ninety subjects were r and omized to a yoga ( n = 43 ) or control group ( n = 47 ) receiving st and ard medical care . Participants were followed 6 months after completion of the intervention . Objective . This study aim ed to evaluate Iyengar yoga therapy on chronic low back pain . Yoga subjects were hypothesized to report greater reductions in functional disability , pain intensity , depression , and pain medication usage than controls . Summary of Background Data . CLBP is a musculoskeletal disorder with public health and economic impact . Pilot studies of yoga and back pain have reported significant changes in clinical ly important outcomes . Methods . Subjects were recruited through self-referral and health professional referrals according to explicit inclusion /exclusion criteria . Yoga subjects participated in 24 weeks of biweekly yoga classes design ed for CLBP . Outcomes were assessed at 12 ( midway ) , 24 ( immediately after ) , and 48 weeks ( 6-month follow-up ) after the start of the intervention using the Oswestry Disability Question naire , a Visual Analog Scale , the Beck Depression Inventory , and a pain medication-usage question naire . Results . Using intention-to-treat analysis with repeated measures ANOVA ( group × time ) , significantly greater reductions in functional disability and pain intensity were observed in the yoga group when compared to the control group at 24 weeks . A significantly greater proportion of yoga subjects also reported clinical improvements at both 12 and 24 weeks . In addition , depression was significantly lower in yoga subjects . Furthermore , while a reduction in pain medication occurred , this was comparable in both groups . When results were analyzed using per- protocol analysis , improvements were observed for all outcomes in the yoga group , including agreater trend for reduced pain medication usage . Although slightly less than at 24 weeks , the yoga group had statistically significant reductions in functional disability , pain intensity , and depression compared to st and ard medical care 6-months postintervention . Conclusion . Yoga  improves functional disability , pain intensity , and depression in adults with CLBP . There was also a clinical ly important trend for the yoga group to reduce their pain medication usage compared to the control group Study Design . Two r and omized , prospect i ve clinical trials involving 238 chronic low back disability patients were carried out . Results at 2‐year follow‐up are presented . Objectives . To compare the clinical outcomes of a multidisciplinary functional restoration program with a nontreated control group ( Project A ) and with two less intensive but different training programs ( Project B ) . Summary of Background Data . The effectiveness of functional restoration programs has not been firmly established . Results from trials carried out in the United States differ from those in trials conducted in other countries . Only a few of these studies have been carried out as prospect i ve and r and omized clinical studies . Methods . Two hundred thirty‐eight patients with chronic low back disability of at least 6 months ' duration were included . There were 106 patients in project A and 132 patients in project B. Two years after completion of treatment , patients were mailed a question naire that included questions regarding their work status , pain and disability levels , number of sick leave days , number of medical care contacts , medication use , physical activity levels , and subjective overall assessment of their " back life situation . " Results . Patients in both studies were comparable at inclusion , except that patients in Project A were recruited from all of Denmark , whereas those in Project B were from the greater Copenhagen area . Thirteen patients did not report for treatment after r and omization . Of the remaining 225 patients , 20 ( 9 % ) did not complete treatment . The question naire response rate was 94 % . In Project A , those patients receiving treatment ( functional restoration ) reported significantly less contact with the health care system , fewer sick leave days , and a less disabled life style during the follow‐up period , compared with reports of patients in the control group . Other effect parameters did not demonstrate a significant difference between the two groups . In Project B , all effect parameters reported , except leg pain and medication usage , were significantly in favor of functional restoration , compared with reports from the less intensively treated groups . Conclusions . The functional restoration program seems effective in various parameters compared with the less intensive programs , but the differences in outcome in the two parallel studies indicate the necessity of testing a treatment program in different setting s , in that the statistical variation may be a major factor in results of different studies Study Design . A r and omized controlled trial was performed . Objectives . To evaluate how 2 different treatment options affect perception of health , pain , and physical functioning over time among children and adolescents with low back pain ( LBP ) . Summary of Background Data . LBP among children and adolescents has increased . The literature shows that children with LBP also suffer from this condition as adults . Thus , it is important to prevent and treat LBP in children and adolescents . Methods . Forty-five children and adolescents were consecutively r and omized into one of 2 treatment groups and were studied for 12 weeks . Group 1 was given individualized physical therapy and exercise and a st and ardized self-training program and back education . Group 2 was given self-training program and back education but no individualized therapy . The children and adolescents were tested before and after the treatment period .  Child Health Question naire Child Form 87 , Rol and & Morris Disability Question naire , Painometer , Back Saver Sit and Reach , and test of trunk muscle endurance  were used to evaluate the interventions . Results . Both groups improved statistically significant in most parameters over time . On comparison between the groups the physical function measured by Rol and & Morris Disability Question naire and the duration of pain measured by Painometer improved statistically significant in Group 1 . Conclusion . An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function , pain , strength , and mobility , regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist To explore the value of anti and rogen therapy for advanced prostate cancer , two clinical trials of similar design were recently conducted in six countries throughout Europe . A total of 550 patients with previously untreated metastatic prostate cancer were r and omized either to treatment with an anti and rogen or castration .  While time to treatment failure , objective tumour response and survival were expected to be similar between study treatments , their effects on health-related quality of life ( HRQOL ) were expected to differ and were therefore a focus of concern in this trial . To assess these effects , we developed a brief self-administered patient question naire covering 10 domains of HRQOL ( general health perceptions , pain , emotional well-being , vitality , social functioning , physical capacity , sexual interest , sexual functioning , activity limitation and bed disability ) , which we translated from English into several other language s. In this paper , we describe the development , content and translation of this survey instrument and report on its reliability and validity in six countries based on data collected for the first 487 patients to complete question naires at study entry Study Design . A pre‐ versus postintervention with concurrent control group design was used to investigate the effect of a workplace‐based early intervention program on perception of disability in nurses with low back injury . Objectives . This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Question naire in two groups of back‐injured nurses‐those who received the early intervention program ( study ) and those who were not offered the program ( control ) . Summary of Background Data . Early intervention programs can decrease morbidity , time lost from work , and compensation costs . Although perception of disability decreases , some residual disability remains , the nature of which is not clear . Methods . The Oswestry Low Back Pain and Disability Question naire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined . Analysis of variance was used to compare changes in mean overall scores over time . The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Question naire at each time period was compared with the results of a chi‐square test . Results . Overall Oswestry Low Back Pain and Disability Question naire scores were similar between study and control nurses at time of injury , but were significantly lower in study nurses at 6 months after injury . However , scores of individual Oswestry Low Back Pain and Disability Question naire components that related to job dem and s increased over time ; this was most apparent in lifting , particularly in study nurses . Conclusions . Although overall perception of disability decreased 6 months after injury , particularly in study nurses , disability in job‐related activities persisted . Residual disability after back injury should be addressed in workplace‐based prevention programs OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Study Design A prospect i ve survey of patients seeking primary care for low back pain . Clinical and psychosocial data , available at presentation , were explored for predictors of outcome at 1 year . Objectives To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis . Summary of Background Data Current treatment strategies for low back pain have failed to stem the rising levels of disability . Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients , but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated . Methods Two hundred fifty-two patients with low back pain , presenting to primary care , underwent a structured clinical interview and completed a battery of psychosocial instruments . Follow-up was done by mail at 1 year ; outcome was measured using a back pain disability question naire . Predictive relationships were sought between the data at presentation and disability at follow-up . Results Most patients showed improved disability and pain scores , although more than half had persisting symptoms . Eighteen percent showed significant psychological distress at presentation . Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain ; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble . Discriminant models successfully allocated typically 76 % of cases to recovered/not-recovered groups , largely on the basis of psychosocial factors evident at presentation . Conclusions Early identification of psychosocial problems is important in underst and ing , and hopefully preventing , the progression to chronicity in low back trouble Study Design . A prospect i ve cohort study of patients with subacute occupational back pain . Objectives . To study the relation between a marketed opto‐electric device measuring trunk kinematics , a widely used specific functional capacity question naire , and work status in back pain patients , and to assess the responsiveness to change in work status of the opto‐electric device and the question naire . Summary of Background Data . Several instruments have been developed to evaluate the functional capacities of patients with back pain , but the relation between these instruments and work status has rarely been studied . Methods . The relation between the opto‐electric device , the question naire , and work status in patients with back pain was evaluated . The study population was a prospect i ve cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks . All data were compiled blindly on the same day , at study entry ( 4 weeks after work accident ) , and at 12 , 24 , and 52 weeks after the work accident . The validity of the question naire and opto‐electric device scores was assessed with partial correlation analyses , st and ardized response mean , logistic regression analyses , and receiver operating characteristics curves . Results . The correlation between the question naire and opto‐electric device scores was low . The question naire scores were significantly related to work status , but the opto‐electric device scores were not . The question naire was responsive to change in work status , whereas the opto‐electric device was not . Conclusions . The opto‐electric device scores were not related to either functional capacity scores ( question naire ) or work status in patients with low back pain , and the opto‐electric device was not responsive to change in work status . Conversely , the question naire was related to work status and was responsive to change in work status Study Design . A r and omized controlled study investigated the effects of therapeutic climbing in patients with chronic low back pain . Before and after 4 weeks of training , physical and mental well-being were measured by two question naires ( 36-Item Short Form Health Survey [ SF-36 ] ; Hannover Functional Ability Question naire for measuring back pain – related disability [ FFbH-R ] ) . Objective . Therapeutic climbing has been suggested to increase muscular strength and perceived physical and mental well-being . This study focused on the psychological effects of therapeutic climbing and compared it with st and ard exercise therapy . Summary of Background Data . Therapeutic climbing has become increasingly popular in rehabilitation and its effects on muscular strengthening have been shown . Therapeutic climbing has also been suggested to yield psychological effects such as changes in attentional focus from pain to physical capabilities . To date , no controlled clinical trial has investigated these psychological effects and it is unclear whether therapeutic climbing is comparable or superior to other forms of exercise . Methods . Twenty-eight patients with chronic low back pain conducted either a therapeutic climbing or a st and ard exercise regime . Each program took 4 weeks , including four guided training sessions per week . Before and after the program , patients answered two question naires assessing their physical and mental well-being . Results . For the Hannover Functional Ability Question naire for measuring back pain – related disability , there was no difference before versus after or between the treatments . For the SF-36 , both treatments showed significant improvements in 3/8 subscales of the SF-36 . In 2/8 subscales , only the participants of the therapeutic climbing improved and in 1/8 subscales the converse was true . Comparing both groups , significantly larger improvements were found after therapeutic climbing in two subscales of the SF-36 : physical functioning and general health perception . Conclusion . The benefits of therapeutic climbing were comparable with those of a st and ard exercise regime . In two subscales of the SF-36 , the benefits of therapeutic climbing exceeded those of st and ard exercise therapy , primarily in perceived health and physical functioning of the patients . This finding demonstrates that therapeutic climbing is equivalent and partly superior to st and ard exercise therapy for patients with chronic low back pain OBJECTIVE French validation of the Foot Function Index ( FFI ) , self- question naire design ed to evaluate rheumatoid foot according to 3 domains : pain , disability and activity restriction . METHODS The first step consisted of translation/back translation and cultural adaptation according to the vali date d methodology . The second stage was a prospect i ve validation on 53 patients with rheumatoid arthritis who filled out the FFI . The following data were collected :  pain ( Visual Analog Scale ) , disability ( Health Assessment Question naire ) and activity restrictions ( McMaster Toronto Arthritis question naire ) . A test/retest procedure was performed 15 days later . The statistical analyses focused on acceptability , internal consistency ( Cronbach 's alpha and Principal Component Analysis ) , test-retest reproducibility ( concordance coefficients ) , external validity ( correlation coefficients ) and responsiveness to change . RESULTS The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis . The Cronbach 's alpha ranged from 0.85 to 0.97 . Reproducibility was correct ( correlation coefficients>0.56 ) . External validity and responsiveness to change were good . CONCLUSION The use of a rigorous methodology allowed the validation of the FFI in the French language ( FFI-F ) . This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot . The FFI-F could be used in other pathologies with foot-related functional impairments
Most of the outcome question naires had a mixed content reflecting various constructs such as pain and symptoms , sleep disturbances , psychological dysfunctions , physical impairments , and social functions .
STUDY DESIGN A systematic literature review of outcome question naires design ed for assessing functional status or disability in patients with low back pain .
OBJECTIVES To provide a comprehensive overview of all functioning/disability question naires used in recent years and to explore how the main concept(s ) was described or defined in the original paper , the content or the domains of disability , and the measurement properties of the question naires .
SUMMARY OF BACKGROUND DATA A number of clinical tools design ed for evaluating the functional status of patients with low back pain have been developed .
Only a few have been review ed earlier , and there has been little focus on the content reflected in the question naires .