Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. The development of a model for translation of the Neck Disability Index to utility scores for cost-utility analysis in cervical disorders. The validity and reliability of the functional rating index for evaluating low back pain in athletes. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method? Evaluation of a randomized controlled trial in the management of chronic lower back pain in a French automotive industry: an observational study. Clinimetric properties of the EuroQol-5D in patients with chronic low back pain. Function and the patient with chronic low back pain. Outcome measures in chronic low back pain A New Approach to the Measurement of Quality of Life: The Patient‐Generated Index Responsiveness of functional status in low back pain: a comparison of different instruments Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV). Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Development and Initial Validation of the Back Pain Functional Scale Translation and Validation Study of the Iranian Versions of the Neck Disability Index and the Neck Pain and Disability Scale Sensitivity and Specificity of Outcome Measures in Patients with Neck Pain: Detecting Clinically Significant Improvement
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 BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life BACKGROUND CONTEXT The Neck Disability Index ( NDI ) is a commonly used disease-specific instrument for cervical spine disorders with good responsiveness and psychometric properties compared with general health status measures . However , NDI scores are unitless and do not have an intrinsic value that is comparable to other health status measures , and these scores have limited value in cost-utility analysis . The translation of disease-specific measures to Short Form-6 Dimensions ( SF-6D ) utility scores may be useful in cost-utility analysis . PURPOSE The purpose of this study is to present a model for translating the NDI to SF-6D utility scores , permitting the use of NDI scores in the cost-utility analysis of cervical disorders . STUDY DESIGN / SETTING A secondary analysis of a multicenter prospect i ve clinical trial of the Synthes ProDisc-C ( Synthes , West Chester , PA , USA ) was performed . PATIENT SAMPLE Patients included were r and omized to receive either a total disc arthroplasty or anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease involving one vertebral level between C3 and C7 . All subjects completed NDI and 36-Item Short Form Health Survey ( SF-36 ) self- assessment s at preoperative and postoperative follow-ups of 6 weeks , 3 , 6 , 12 , 18 , and 24 months . OUTCOME MEASURES The NDI is a vali date d and widely used self-reported question naire design ed to assess patient-determined disability result ing from neck pain , including pain level and effects on activities of daily living . The SF-6D is a preference-based health state classification system derived from six health dimensions of the SF-36 self-reported question naire , including the domains of physical functioning , role limitation , social functioning , bodily pain , mental health , and vitality . METHODS The collected data points were divided into two cohorts : one for model formation and one for the assessment of model validity . SF-36 scores were converted to SF-6D utilities via three previously published methods . Correlation analyses and linear regression modeling between SF-6D and NDI created the models for translating scores . For validation , Spearman and Pearson correlations were calculated between the observed and predicted SF-6D utilities , and prediction errors were calculated . RESULTS Four hundred thirty patients with 2,137 time points were used for creation and validation of the model . Pearson and Spearman correlation coefficients between the NDI and the SF-6D derived from each conversion method were found to be between -0.8255 and -0.8504 ( p<.01 ) . R(2 ) values ranged from 0.68 to 0.71 and root mean squared error ( RMSE ) from 0.092 to 0.084 . Correlations between estimated and observed SF-6D scores ranged from 0.8325 to 0.8372 ( p<.01 ) . The mean prediction error was less than 0.006 , with st and ard deviation ( SD ) between 0.082 and 0.093 . DISCUSSION Correlations between NDI and SF-6D utility scores are strong and statistically significant . The model has a large R(2 ) and small RMSE . The prediction models produce a small mean prediction error , but the SD of the prediction errors is large . High correlations between NDI and SF-6D permit these models to be used to calculate overall utilities , changes in utilities , and quality -adjusted life-years for large data sample s. However , the relatively large observed prediction error SDs may limit the accuracy of translation of individual data points or small sample sizes 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 Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and The main goal of current pain management approaches is to increase the patients ' quality of life by improving pain coping skills and by reducing the levels of disability in daily life , often despite persistent pain . Direct measurement of quality of life is of crucial importance in economic evaluation research , in which not only is the estimation of financial costs and benefits included , but so is the evaluation of costs and benefits in terms of changes in health states . The purpose of this study is to compare the psychometric qualities of two instruments for assessing patients ' utilities , the  rating scale ( RS )  and the st and ard gamble ( SG ) . Such instruments are design ed for their application in economic evaluation research , but have seldomly been used in chronic pain trials . Both methods provide a single measure between 0 and 1 . The relationship between these utility measures and descriptive and domain-specific quality of life measures was examined in 133 fibromyalgia patients and 148 patients with chronic non-specific low back pain .  Mean utility score at baseline was 0.43 with the RS and 0.78 for the SG . The correlation between both methods was found to be poor ( r = 0.21 ) . Both measures appeared to be fairly stable in a 2-week test-retest period ( intra class correlation coefficient ( ICC ) = 0.74 and 0.77 ) . Scores on the description of patient 's own health on six domains , global assessment of change and domain specific measures correlated moderately with the RS scores and low with the SG . Multiple regression analyses demonstrated that 32 % of the variance in RS values and only 13 % of the variance in SG utilities could be explained by domain-specific measures . These results suggest an acceptable construct validity for the RS but insufficient construct validity for the SG . Valuations of ones own health appear only partially to be related to the assessment of the pain-specific measures and measures of distress . It can be concluded that the RS and domain-specific measures assess partly different , but nevertheless complementary aspects of health-related quality of life . It is therefore recommended to include in economic evaluation studies both domain-specific measures and valuation measures . Finally , in chronic musculoskeletal pain patients , RS scores were found to be more responsive in detecting significant changes in preferences than SG scores . For use in patients with chronic musculoskeletal pain , the RS is preferred to the SG for establishing accurate decisions about the impact of new interventions on their health outcomes OBJECTIVE To evaluate a specific workplace intervention for the management of  chronic lower back pain among employees working in assembly positions in the automotive industry . DESIGN R and omized controlled trial . SETTING On site at the workplace of a French automotive manufacturer . PARTICIPANTS Subjects ( N=75 volunteers ) were recruited on site and r and omly assigned to either an experimental group ( n=37 ) or a control group ( n=38 ) . INTERVENTION The experimental group followed a supervised 60-minute session , 3 times per week , of muscle strengthening , flexibility , and endurance training during 2 months . The control group received no direct intervention . Evaluation took place at baseline , 2 months , and 6 months . MAIN OUTCOME MEASURES Pain related parameters were evaluated using vali date d question naires and scales translated into French ( Quebec Back Pain Disability Scale , Rolan Morris Disability Question naire , Dallas Pain Question naire , and the Tampa Scale for Kinesiophobia ) . Perceived pain intensity was evaluated using the numerical rating scale , and physical outcome measures were evaluated using specific indicators ( flexibility , Biering-Sorensen Test , Shirado test ) . The multivariate analysis of variance , t test , and Wilcoxon signed-rank test were used for statistical analysis . RESULTS We observed a significant beneficial effect ( P<.025 ) for the experimental group at 2 and 6 months in pain parameters , specific flexibility , and in back functions , and a significant improvement at 6 months in the control group for the perceived pain intensity , anterior flexion , flexibility of quadriceps , and Dallas Pain Question naire 's work recreational score . An increase in the practice of physical activity outside the workplace was noted in both groups at 2 months but persisted at 6 months for the experimental group . CONCLUSIONS This study reinforces the multiple health benefits of physical activity and physical therapy modalities in the workplace by assisting individuals at risk who have chronic LBP BACKGROUND CONTEXT Clinimetric properties of the EuroQol-5D ( EQ-5D ) in patients with nonspecific chronic low back pain ( CLBP ) are largely unknown . PURPOSE To study the criterion validity , responsiveness , and minimal clinical ly important change ( MCIC ) of EQ-5D in patients with CLBP . STUDY DESIGN Prospect i ve study design carried out in a multispecialist Spine Center in The Netherl and s. PATIENT SAMPLE One hundred fifty-one patients with CLBP . OUTCOME MEASURES Quality of life ( QOL ) was measured with EQ-5D , consisting of two scales : one scale measuring QOL with five categorical questions and the other measuring health state on a visual analog scale ( 0 - 100 ) . Criterion measures were disability , measured with the Pain Disability Index ( PDI ) and the Rol and Morris Disability Question naire ( RMDQ ) , and pain intensity , measured with a numeric rating scale ( NRS ) . METHODS Pearson correlation coefficients between the EQ-5D and RMDQ , PDI , and NRS were calculated to test the criterion validity . Correlations were interpreted based on predefined criteria . Responsiveness of the EQ-5D was calculated with area under the receiver operating characteristics ( ROC ) curve . Minimal clinical ly important change was calculated with the optimal cutoff point under the ROC curve , and sensitivity and specificity were also calculated . RESULTS Correlations between EQ-5D and criterion measures ranged between 0.39 and 0.59 and were considered moderate to good . Areas under the ROC curve ranged from 0.59 to 0.72 depending on the external criterion and EQ-5D subscale . The MCIC was 0.03 points for the categorical scales of the EQ-5D and 10.5 points for the EQ-5D visual analog scale . CONCLUSIONS The EQ-5D is a valid and responsive QOL scale in patients with CLBP 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 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 Quality of life has been defined as “ the extent to which our hopes and ambitions are matched by experience . ” To improve a patient 's quality of life through medical care would be to “ narrow the gap between a patient 's hopes and expectations and what actually happens . ” Using the above definition as a conceptual basis , we produced a self-administered , Patient-Generated Index ( PGI ) of quality of life .  The PGI was completed by 359 patients presenting with low back pain . The validity of the measure was assessed by correlating patients ' PGI scores with a well-vali date d health profile , the Short-Form 36-item Health Survey ( SF-36 ) , and with their scores on a clinical back pain question naire . Stepwise multiple regression was then used to model the relationship between the PGI score and the SF-36 . Patients ' PGI scores showed a high correlation with SF-36 scales measuring pain , social functioning , and role limitations attributable to physical problems , and with the clinical question naire . Together with whether a person was retired or not , these health variables were able to explain 25 % of the variance in PGI scores . Patient generated index scores were significantly lower in patients referred to hospital compared with those managed solely in general practice and tended to reflect the general practitioner 's assessment of symptom severity . We conclude that it is possible to construct a question naire that quantifies the effect of a medical condition on patients ' quality of life in a way that has meaning and relevance in the context of their daily lives . The PGI has considerable potential for routine use in a wide range of clinical conditions for which the measurement of outcome has hitherto proved very difficult & NA ; This study compares the responsiveness of three instruments of functional status : two disease‐specific question naires ( Oswestry and Rol and Disability Question naires ) , and a patient‐specific method ( severity of the main complaint ) . We compared changes over time of functional status instruments with pain rated on a visual analog scale . Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used : effect size statistics and receiver‐operating characteristic method . We chose global perceived effect as external criterion . A cohort of 81 patients with non‐specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment . According to the external criterion 38 patients improved . The results of both strategies were the same . All instruments were able to discriminate between improvement and non‐improvement . The effect size statistics of the instruments were higher in the improved group than in the non‐improved group . For each instrument the receiver‐operating characteristic curves showed some discriminative ability . The curves for the Rol and Question naire and pain were closer to the upper left than the curves for the other instruments . The sensitivity to change of the rating of Oswestry Question naire was lower than that of the other instruments . The main complaint was not very specific to change . The two strategies for evaluating the responsiveness were very useful and appeared to complement each other The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory , MPI-DLV . Data was available on 733 chronic pain patients . There were three issues of special interest . The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects . The second dealt with the construct validity of the  MPI-DLV scale ' general activity ' . It was predicted that patients with high scores on this scale would be in better physical condition , as measured on a working-to-tolerance bicycle ergometer test . In relation to the third issue , attention was given to the factor-invariance between fibromyalgia patients and back pain patients . From the results obtained it was concluded that ( 1 ) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions ; ( 2 ) patients with high scores on the ' general activity ' scale are in better physical condition and ( 3 ) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures . Evidence was also obtained that the  MPI-DLV  is sensitive to treatment changes . Applications of the MPI-DLV are discussed 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 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 . Cultural translation and psychometric testing . Objective . To translate and vali date the Iranian versions of the Neck Disability Index ( NDI-IR ) and the Neck Pain and Disability Scale ( NPDS-IR ) . Summary of Background Data . The widely used the NDI and the NPDS scales have not been translated and vali date d for Persian-speaking patients with neck pain . This was to provide a vali date d instrument to measure functional status in patients with neck pain in Iran . Methods . The translation and cultural adaptation of the original question naires were carried out in accordance with the published guidelines . One hundred and eighty-five patients with neck pain were participated in the study . Patients were asked to complete a question naire booklet including the NDI-IR , the NPDS-IR , the Iranian SF-36 , and a visual analog scale ( VAS ) of pain . To carry out the test-retest reliability , 30 r and omly selected patients with neck pain were asked to complete the question naire booklet 48 hours later for the second time . Results . Cronbach & agr ; coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory ( ranging from 0.74 to 0.94 ) . The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability ( intraclass correlation coefficient ranged from 0.90 to 0.97 ; P < 0.01 ) . The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results , indicating a good convergent validity ( Pearson correlation coefficients ranged from −0.31 to −0.70 ) . The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 ( P < 0.01 ) . Conclusion . The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran . They are simple and easy to use and now can be applied in clinical setting s and future outcome studies in Iran and other Persian speaking communities Study Design . Prospect i ve , single-cohort study . Objective . To determine the relative sensitivity of a range of outcome measures used in evaluating treatment interventions in patients with neck pain and the magnitude of change scores on the neck Bournemouth Question naire and the cutoff score on the Patients ’ Global Impression of Change scale associated with clinical ly significant improvement . Summary of Background Data . Traditionally , evaluation of treatment interventions using subjective outcome measures has been based on the statistical significance of the difference between group mean values . To be clinical ly meaningful , however , information is required from sensitive outcome measures on the proportion of patients undergoing a clinical ly important improvement and from this , the number needed to treat for a single patient to benefit . Methods . Patients with nonspecific neck pain from a number of treatment centers completed a battery of self-report question naires , including the Bournemouth Question naire , before and after chiropractic treatment . After treatment , patients also completed a retrospective analysis of their overall improvement since the start of treatment ( Patients ’ Global Impression of Change ) . The a priori definition of clinical ly significant improvement was defined as a Reliable Change Index on the Bournemouth Question naire of > 1.96 . Results . The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients ’ Global Impression of Change ( 11-point Numerical Rating Scale : 0 = much better , 5 = no change , and 10 = much worse ) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Question naire . For the total score of the Bournemouth Question naire , raw change scores of 13 or more points , percentage change scores of 36 % or more , and individual effect sizes of 1.0 or more were all associated with clinical ly significant improvement . The sensitivity of the Bournemouth Question naire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index . Conclusions . The present findings will assist in the choice of outcome measures in trials on neck pain . The study also illustrates a method ologic framework for interpreting change scores in terms of clinical improvement , facilitating the process of making sense of research data in the clinical setting
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 .