COSMIN database

Assessing dimensionality and responsiveness of outcomes measures for patients with low back pain

Cleland, J., Gillani, R., Bienen, E. J., and Sadosky, A.
OBJECTIVE: To provide a systematic literature review of the responsiveness of patient-reported health outcomes measures for the evaluation of low back pain (LBP).

METHODS AND DESIGN: Searches of MEDLINE and EMBASE were performed for articles published in English through June 29, 2009 using the search terms "back pain" or "low back pain" and "questionnaires" or "instrument" or "survey" or "measure" or "patient report outcome." Information on responsiveness was gathered through additional measure-specific searches that included the measure name, first author of the original paper, and "respons*" or "sensit*." Responsiveness was determined based on use of a receiver operating characteristics curve or effect size statistics.

RESULTS: Of 43 identified measures, 31 were reported as being responsive to treatment or clinical change, 25 of which were evaluated for responsiveness using methods considered adequate. When considering both the responsiveness evaluation and the underlying factor structure, 13 measures were identified as being adequately validated for use in evaluating responsiveness in the research or clinical practice setting. The majority of the LBP outcome assessment studies were comprised of patients undergoing physical and interventional therapies from clinical practice and clinical trials. The Roland Morris Disability Questionnaire and the Oswestry Disability Index were the most comprehensively validated measures with respect to responsiveness.

CONCLUSIONS: We identified 13 measures of LBP that can be used to evaluate responsiveness to change. Choice of a measure warrants careful evaluation of its construct and responsiveness properties in order to maximize the observed impact on pain and functional improvement in subjects with LBP.
Pain Pract
1533-2500 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
Role functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
ABPS / ALBPS - Aberdeen (Low) Back Pain Scale    |  | also see:
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
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 - Oswestry Disability Index   
OMLSS - Outcome Measure for Lumbar Spinal Stenosis
ORQ - Occupational Role Questionnaire
PRAP - Pain Response to Activity and Position Questionnaire
PSA - Patient-specific approach
QBPDS - Quebec Back Pain Disability Scale   
RADL - Resumption of Activities of Daily Living Scale
RMDQ - Roland Morris Disability Questionnaire    
RS - Low Back Rating Scale
SPIM - Spinal Pain Independence measure
WDI - Waddell Disability Index