COSMIN database

Functional status and disability questionnaires: what do they assess? A systematic review of back-specific outcome questionnaires

Grotle, M., Brox, J. I., and Vollestad, N. K.
STUDY DESIGN: A systematic literature review of outcome questionnaires designed for assessing functional status or disability in patients with low back pain.

OBJECTIVES: To provide a comprehensive overview of all functioning/disability questionnaires 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 questionnaires.

SUMMARY OF BACKGROUND DATA: A number of clinical tools designed for evaluating the functional status of patients with low back pain have been developed. Only a few have been reviewed earlier, and there has been little focus on the content reflected in the questionnaires.

METHODS: Papers including questionnaires for assessing disability, function, activity limitations, or participation restrictions in adult patients with low back pain were searched in the MEDLINE and CINAHL databases for the period from January 1996 to January 2002. Two independent and blinded researchers read and selected abstracts and questionnaires. The content of the included questionnaires was classified according to World Health Organization's International Classification of Functioning, Disability and Health. The measurement properties were analyzed according to recommended guidelines.

RESULTS: A total of 36 back-specific questionnaires were identified. When distinguishing among a bodily, personal, and social perspective of functioning, 4 main types of content were identified. Most of the outcome questionnaires had a mixed content reflecting various constructs such as pain and symptoms, sleep disturbances, psychological dysfunctions, physical impairments, and social functions. Nine questionnaires assessed solely activities of daily living. For one-third of the questionnaires, the measurement properties were reported in only the original study.

CONCLUSIONS: Although most questionnaires had their main focus on activity limitations, a considerable variation with respect to the main concept and content was found. Only a few of the questionnaires can be considered acceptably validated
Publication year:
Symptom status:
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Social functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
BACK-ILL - Back Illness Pain and Disability 9-item Scale
BDS - Back dysfunction score
BPFS - Back Pain Functional Scale
BPI - Back Pain Interference Scales
BQ - Bournemouth Questionnaire
CBPQ - Clinical Back Pain Questionnaire
DPQ - Dallas Pain Questionnaire
DRI - Disability Rating Index   
FFbH (Also FFbH-R) - Funktionsfragenbogen, Hannover [alias: Hannover Functional Ability Questionnaire]
FOQSD - Functional Outcomes Questionnaire for Spinal Disorders
FRI - Functional Rating Index   
GFS - General Function Score
JOA LBP - Japanese Orthopaedic Association Low BAck Pain assessment
JVB - Jan van Breemen Functional Scale
LBOS - Low Back Outcome Scale
LBP Rating Scale
Million Scale
NASS - North American Spine Society Questionnaire (versions: lumbar spine outcome; NASS-cervical - NASS-cervical outcome; NASS-AAOS - North American Spine Society-American Academy of Orthopedic Surgeons)
ODI 2.0 - Oswestry Disability Index, 2.0
ODI AAOS - Oswestry Disability Index AAOS/MODEMS
ODI Chir - Oswestry Disability Index Chiropractic Version
ODI - Oswestry Disability Index   
OMLSS - Outcome Measure for Lumbar Spinal Stenosis
ORQ - Occupational Role Questionnaire
PRAP - Pain Response to Activity and Position Questionnaire
PSQ -Patient Specific Questionnaire
QBPDS - Quebec Back Pain Disability Scale   
RADL - Resumption of Activities of Daily Living Scale
RMDQ - Roland Morris Disability Questionnaire    
SPIM - Spinal Pain Independence measure
WDI - Waddell Disability Index