Section 3: Torso Examination

PATIENT-REPORTED OUTCOME MEASURES

The multifactorial nature of low back pain, combined with the difficulty in identifying its specific cause, makes the use of outcome measures extremely important in understanding the impact of pain on a patient’s life.¹ The Oswestry Disability Index and the Roland-Morris Disability Questionnaire are commonly used when assessing low back pain. However, these outcome measures may result in a ceiling effect when used with highly active patients with transient conditions. Generic measures, described in the Section 1 opener, are also often used in clinical practice and research. Additionally, because low back pain is often associated with fear avoidance beliefs and symptoms of depression, a variety of different scales should be used to determine their influence.¹

Oswestry Disability Index (ODI)

The ODI is the most commonly used outcome measure for low back pain. It 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 the worst symptoms. The total score is then doubled and reported from 0 to 100, with higher scores representing greater levels of disability.²

• Minimal Detectable Change: 15–19³

• Minimally Clinically Important Difference: 10-point change from baseline

Quebec Back Pain Disability Scale

This instrument is self-administered by patients with general low back pain, sacroiliac joint dysfunction, and postlumbar spine surgery. Consisting of 20 questions, the patient rates their difficulty in performing a variety of activities ranging from getting out of bed to walking long distances using a 6-point scale from 0 (no difficulty) to 5 (unable to do). Scores range from 20 to 100, with higher scores representing greater disability.⁴

• Minimum Detectable Change: 10–15⁴

• Minimally Clinically Important Difference: Unknown

Roland-Morris Disability Questionnaire (RDQ)

The RDQ consists of 24 yes/no items designed to assess the impact of pain on the patient’s perceived disability over the previous 24 hours. Scores range from 0 to 24, with higher scores representing greater levels of disability. The RDQ may be more discriminatory in patients with mild and moderate disability than in those with severe disability. The scale can be easily accessed online (http://www.rmdq.org/) and is available in several languages.

• Minimum Detectable Change: 2–7, depending on time interval, treatment type, and baseline scores⁵

• Minimum Clinically Important Difference: 2–7 in patients with baseline scores <10; 5.5–13.8 in patients with baseline scores >15⁶

Beck Depression Inventory (BDI)

Symptoms of depression are a frequent comorbidity in patients with low back pain. The 21-item BDI screens for the presence and severity of depression. For each item, the patient selects ...