How many questionnaires? That's an interesting question. There are a lot. I think they break down into two broad categories: functional questionnaires, such as the Oswestry LBP Disability Index, Roland-Morris Disability Questionnaire and the Patient-Specific Functional Scale (PSFS); and mechanism-related questionnaires, such as the Fear-Avoidance Beliefs Questionnaire, the Pain Catastrophizing Scale, the Pain Beliefs Screening Instrument, etc. All of these pain-related mechanism questionnaires, of course, have been used for a variety of musculoskeletal pain problems. Some have better psychometric properties than others, but my biggest concern with respect to chronic, non-specific LBP has turned towards promoting internal locus of control/self-efficacy very early in the treatment interaction. For this reason, I prefer to use the PSFS.

There are self-report questionnaires that examine self-efficacy in particular such as the Pain Self-Efficacy Scale. There's also a tool developed by Denison and Sandborgh called the Pain Beliefs Screening Instrument, which combined the most discriminative questions from several self-report instruments to provide a more comprehensive picture of the patient's psychosocial profile. I'm going to be using it in my doctoral project study, in fact.

There are also generic health status/functional questionnaires such as the SF-36 and the Global Rating of Change scale. I use the latter as well for my LBP patients.

Thank you for your descriptive answer. If you have any systematic review/ any review on this topic then I would surely like to read it. Please let me know.

A systematic review of self-report measures for non-specific LBP? I think you should be able to find one, if there are any, by using the search terms: "low back pain" "self-report", "outcomes", "systematic review" at Pubmed. You may want to check CINAHL as well.

Well,

you can also look at the BACKILL (after "back" and "illness") scale. Its' very "general" in the realm of "back pain". See my paper published in "Pain" here in my profile.

Regards

Finding ALL scales used for LBP is a daunting task. I performed a quasi systematic search in 1999-2000 which is published in Spine ("Lessons learned searching for a HRQoL instrument to assess the results of treatment in persons with lumbar disorders."). You can find it in my profile. Of course it needs to be updated. I also saw recently this publication in pubmed, but haven't read it:

Rating scales for low back pain.

Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V.

Br Med Bull. 2010;94:81-144. doi: 10.1093/bmb/ldp052. Epub 2010 Jan 10. Review

Hope this helps, good luck

Yes I read it before (Longo et al) but I would definitely like to look at your study you mentioned here. Thank you for adding this information Gustavo Zanoli.

Dear colleaugues,

There are an enormous number of instruments and questionnaires available to assess all type of patient variables. The total number is now estimated to be between 500 and 600 in the field of musculoskeletal disorders alone. For pratical purposes, a set of 10 - 15 instruments / questionnaires are enough to describe about 85% of all patients with musculoskeletal disorders. The first issue raised is how to choose a clinimetric index. The second concerns the methodological or psychometric properties of the indexes.

The European Research Group on Health Outcome (ERGHO) has published a statement entitled 'Choosing a health outcome measurement outcome which is applicable to all clinimetrical indexes'. In chossing a measurement instrument (for example an evaluative instrument) to be asked is 'What is the aim (construct) of the index.

The International Classification of Functioning, Disability and Health (ICF) is a good starting point for the first choice of outcome measures and measurement instruments in clinical situatuions, particurly because diagnostic assessment by physical therapist is concerned mainly with functional disorders such as low back pain.

Based on the ICF and the clinimetric properties, we have developed a 5-step model in selecting the appropriate instruments and / or questionnaires. See reference 1.

Based on this model, I give you an overview of the evaluative instruments and questionnaires we have used in different type of studies (case study, observational studies and randomised controlled studies):

. pain: visual analogue scale (VAS), Numeric Pain Rating Scale (NPRS), McGill Pain Questionnaire (MPQ) and pain drawing;

. activities and partiipation: Roland-Morris disability questionnaire (RDQ) and Quebec Back Pain Disability Scale (QBPDS),;

. personal factors: acute low back pain screening questionnaire, chronic pain grade questionnaire, Tampa Scale Kinesiophobia (TSK), Pain Coping Inventory (PCI) and Short Form 36 (SF-36 [general health]).

My answer on your question 'How many self-reported questionnaires are available (currently being used by clinicians and researchers) to assess non-specific lower back pain?' is 11 instruments or questionnaires.

I wish you and qall the colleaugues succes and best greetings from The Netherlands,]

Rob Oostendorp, PhD, MScPT, MPT.

Reference

Swinkels RAHM, Oostendorp RAB. Outcomes assessment and measurement in spinal musculoskeletal disorders. In: Grieve's Modern Manual Therapy. The Vertebral Column (edited by: Boyling, JD, Jull GA). Edinburgh, Churchill Livingstone, 2004.

Dear Rob A B, thank you so much for adding some useful information on this topic and for your warm wishes.

Nice to see you here, Dr. Oostendorp. I'm a fan of your group's research.

I expressed earlier my concern about many of the current outcomes instruments for patients with persistent LBP, including numerical pain rating scales, the Oswestry and the RMDQ. These tools tend to lead the patient in a way that I'm concerned might do two things that we should be avoiding: 1) frustrating the patient by asking them to quantify their pain with a number and 2) wresting locus of control from the patient by having them identify a functional activity that may not be particularly important to them.

The Patient Specific Functional Scale and the Global Rating of Change avoid these pitfalls because the patient self-identifies troublesome activities and is not asked to produce a number to coincide with their pain. I see that neither of them made your list of 11, however.

Dear John and colleaugues,

Thank you for your complement. The Patient Specific Functional Scale (PSFS) is indeed a frequently used questionnaire with individual details of the activities that yielded patient effort. This questionnaire can add to the list.

I can add to the list the following questionnaires:

. the Global Perceived Effect (GPE) questionnaire;

. Photograph Series of Daily Activities (PHODA; an assessment of pain related fear hierarchy).

So, we have a list of 14 questionnaires.

Best regards to all,

Rob Oosrtendorp

Hi Rob John and All;

Just got forwarded this thread and theme so sorry I am 6 months behind!.

The latest to add to the group is

- the Spine Function Index (SFI) in publication in The Spine Journal E-pub 2013 Oct to be in full pub soon!!?

- and the second is software based tools that fall into either a CAT (computer adaptive testing) or DSS (decision support System). CAT has the advantage of brevity and specificity within a pre-determined ~125 items but drawbacks are lack of diversity and patient specificity as well as lack of constructs outside of function alone. DSS provides the optimal solution as it incorporates the 5 essential constructs of patient specificity, function, pain global perceived status and self perceived duties/capacity that are integrated along with age, gender and duration of the condition by algorithms within the software to provide a single evenly weighted score - this is performed in real time with the chart produced and trends to recovery and status shown along with predicted recovery time and risks that affect this within the biopsychosocial model . - see www.adviserehab.com

Consequently it solves the problems outlined above by both john and Rob.

this formed the theme of my PhD thesis!

So In summary Tools are

- Screening for prediction eg Orebro OMSQ-12 BackSTART and some some clinical prediction rules

- General - eg SF-36, 12, etc. EuroQuol;

- Region specific Whole spine - FRI and SFI Bourmouth etc

- Location or Sub region Specific - back or neck

- Condition specific - eg Ank Spond, Spinal Stenosis, SIJ, post paraplegia etc

Hate to be a dampener on the topic but the total potentially found in our study was 129 that was then reduced in the order of ~29 but only 5 of these are applicable to the spine as a single unit and only one - the FRI had acceptable psychometric properties - but also several notable drawback.

Consequently the FRI was used as our criterion and a direct comparison showed it score suitability of 64% compared to 98% for the new SFI (as scored on a clinical performance scales derived from the COSMIN initiative).

A short list of potentially suitable musculoskeletal tools is available in our Article in Phys Ther 2012 92(1) 98-110 - the Lower Limb Functional Index - E-appendices #2.

Bit long but hope it helps

Phil Gabel

Hi Kalpesh;

We summarised the availble tools for LBP in the paper in T Spine J - still in E-pub form -

2013 Oct 25. pii: S1529-9430(13)01598-2. You can dowload it from this site in my pubications list.

Also the e-appendix list fin the Lower Limb Functional Index Paper

The Grotle Article 2005 may be a good start as well -

'Functional status and disability questionnaires: what do they assess? A systematic review of back-specific outcome questionnaires.'  spine 30 (1)130-140

Thank you Charles Philip Gabel. Yes, I already found out Grotle's article. Actually, I am conducting a scoping review on it. So far, I have found out some intersting results and I am hoping to finish it soon. 

This article might be useful

Outcome measures in chronic low back pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989277/