Assessing change over time in patients with low back pain

School of Occupational Therapy and Physiotherapy, McMaster University, Hamilton, Ontario, Canada.

BACKGROUND AND PURPOSE. This study compared the ability of the Roland-Morris (RM), Oswestry (OSW), and Jan van Breemen Institute (JVB) pain and function questionnaires to detect change over time. SUBJECTS. The sample consisted of 88 patients with mechanical low back pain who were referred by physicians to the outpatient physical therapy department of a teaching hospital. METHODS. Questionnaires were completed by the subjects at their initial visit and 4 to 6 weeks later. Clinically important change was estimated by having the subject and the clinician independently complete two rating scales. Sensitivity to change was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS. The ROC curve areas for the RM (0.79), OSW (0.78), and JVB pain (0.79) questionnaires were significantly greater than for the JVB function questionnaire (0.66). Blank and multiple responses per item were present on approximately 20% of the OSW questionnaires and 14% of the JVB questionnaires. Words rather than checks were evident on 3% of the RM questionnaires. CONCLUSION AND DISCUSSION. Based on the latter finding, we believe the RM questionnaire may be the preferred instrument for assessing change over time in patients with low back pain.

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