Torso Examination

Patient-Reported Outcome Measures

The multifactorial nature of low back pain, combined with the difficulty in identifying a structural culprit, means that the use of outcome measures is important in understanding the impact of the pain on the patient's life.¹ The Oswestry Disability Index and the Roland-Morris Disability Questionnaire, both commonly used for patients with low back pain, may suffer from ceiling effects when used with highly active patients who have transient conditions. Generic measures, described in the section opener at the beginning of this text, are also often used. Additionally, because low back pain is often associated with fear avoidance beliefs and symptoms of depression, different scales are often used to determine their influence.¹

Oswestry Disability Index (ODI)

The ODI is the most commonly used outcome measure in patients with low back pain. The ODI includes the following 10 sections, each with six statements from which the patient can choose: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. The modified ODI has slightly different sections. Each selection is scored from 0 to 5, with 5 representing worse symptoms. The total score is then doubled and reported from 0 to 100, with a higher score representing greater disability.²

  Minimal Detectable Change: 15–19³

  Minimally Clinically Important Difference: 10-point change from baseline

Roland-Morris Disability Questionnaire (RDQ)

Consisting of 24 yes/no items, the RDQ assesses the impact of pain on the patient's perceived disability over the past 24 hours. Scores range from 0 to 24, with higher scores representing greater disability. The RDQ may be more discriminatory in patients with mild or moderate disability than in those with severe disability.

  Minimum Detectable Change: 2–7, depending on time interval, treatment type, and baseline scores⁴

  Minimum Clinically Important Difference: 2–7 in patients with baseline scores <10; 5.5–13.8 in patients with baseline scores > 155

Beck Depression Inventory (BDI)

Symptoms of depression are a frequent comorbidity in patients with low back pain. The 21-item BDI is used to screen for the presence and severity of depression. For each item, the patient selects one of four options. Scores range from 0 to 63 and are interpreted as follows:

• 1–10: Normal ups and downs

• 11–16: Mild mood disturbance

• 17–20: Borderline clinical depression

• 21–30: Moderate depression

• 31–40: Severe depression

• >40: Extreme depression²

Fear Avoidance Beliefs Questionnaire (FABQ)

The FABQ is used to assess the patient's fear and the extent to which the patient is avoiding activity in response to low back pain. Because a high FABQ is associated with worse clinical outcomes if not addressed, measuring this psychosocial component is warranted as part of the examination process to determine treatment options.^6,...