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Dear Readers: The Outcome Forms actually stored on our server have been approved for your use by the owners (or copyright holders). If you plan to use them for commercial use, research, or publication, please Google those owners, and ask them for permission. I can not do that for you.
The QAs that we “link to” (that are located on other websites) are ones we couldn't get permission for.
I have provided scoring/grading methods with the questionnaires whenever they have been available. If you utilize these QAs in patient care, you will need those scoring methodologies. I strongly recommend that you purchase Yeoman's The Clinical Application of Outcomes Assessment from Amazon, to get that information.
The best way to copy an Adobe Acrobat (PDF) file from this site is to follow this procedure: “Right-click” the URL (or link), and then select “Save Target As”, then choose the “directory” (in your computer) that you want to save it to. When the item is saved, then select “open file”. Adobe Acrobat files open and print much better when they reside within your own computer, especially with larger documents.
Participate in “Practice-Based Research”
We would like to extend an open invitation to U.S. chiropractors to participate in an exciting new research program at Cleveland Chiropractic College: the Cleveland Practice-Based Research (PBR) Program. PBR is a partnership between practitioners and an academic institution to gather data from real-life practice. Each partner does what they do best: practitioners provide their usual excellent chiropractic care, and the Cleveland Chiropractic Research Center will collect and analyze data to document that care. Read more now!
Outcome Assessment Guidelines
Review these recommendations for Outcome Assessment by a variety of National associations.
The Outcome
Assessment Book Shelf
Please browse our Outcome Assessment book shelf. Any books you purchase will help to support our non-commercial website.
Rand SF-36 ~ in Wordor
as Adobe Acrobat
As part of the Medical Outcomes Study (MOS) — a multi-year, multi-site study to explain variations in patient outcomes — RAND developed the 36-Item Short Form Health Survey (SF-36). SF-36 is a set of generic, coherent, and easily administered quality-of-life measures. These measures rely upon patient self-reporting and are now widely utilized by managed care organizations and by Medicare for routine monitoring and assessment of care outcomes in adult patients. Before downloading the SF-36 you must read
Rand's Disclaimer. This document is formatted to print on both sides of a page, with a larger border on the left-hand side for binding into a file.
Download The Adobe Acrobat Reader for Free
Measuring Functional Health Status in the Chiropractic Office Using Self-Report Questionnaires
Topics in Clinical Chiropractic 1994: 1 (1): 51-59 ~ FULL TEXT
The questionnaire is located on page 81-83.
Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of impending change toward more closely managed health care purchasing, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economic and efficient way of accomplishing the task. Two such instruments are presented in detail: the Dartmouth COOP charts and the RAND 36-Item Health Survey 1.0, the latter of which is included in its entirety for use in the office setting. Several other instruments are briefly summarized.
Development of an Index of Physical Functional Health Status in Rehabilitation
Arch Phys Med Rehabil 2002 (May); 83 (5): 655–665
Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.
The Neck Disability Index: A Study of Reliability and Validity
J Manipulative Physiol Ther 1991 (Sep); 14 (7): 409–415
Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number. A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI).While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.
The Oswestry Disability Index
Spine 2000 (Nov 15); 25 (22): 2940–2952
The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.
The Quadruple Visual Analogue Scale
The Quadruple Visual Analogue Scale
This Adobe Acrobat file covers 4 characteristics of the Patient Complaint: Present Pain, Typical or Average Pain, and Pain Range at it's least and worst.
Responsiveness of Visual Analogue Scale and McGill Pain Scale Measures
J Manipul Physiol Ther 2001 (Oct); 24 (8): 501–504
The results of this study suggest that the VAS may be a better tool than the McGill Pain Questionnaire for measuring pain in clinical trials and clinical practice.
The Patient-Specific Functional Scale
The Patient-Specific Functional Scale
In a recent study, the Patient Specific Functional Scale was the most responsive disability measure in a trail comparing a variety of OA tools. Adobe Acrobat version. No scoring method is available on our website
Responsiveness of Pain and Disability Measures for Chronic Whiplash
Spine 2007 (Mar 1); 32 (5): 580-585
Pain (pain intensity, bothersomeness, and SF-36 bodily pain score) and disability (Patient Specific Functional Scale, Neck Disability Index, Functional Rating Index, Copenhagen Scale, and SF-36 physical summary) measures were completed by 132 patients with chronic whiplash at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Internal responsiveness was evaluated by calculating effect sizes and standardized response means, and external responsiveness by correlating change scores with global perceived effect scores and by ROC curves. The ranking of responsiveness was consistent across the different analyses. Pain bothersomeness was more responsive than pain intensity, which was more responsive than the SF-36 pain measure. The Patient Specific Functional Scale was the most responsive disability measure, followed by the spine-specific measures, with the SF-36 physical summary measure the least responsive.
The Copenhagen Neck Functional Disability Scale:
A Study of Reliability and Validity
J Manipulative Physiol Ther 1998 (Oct); 21 (8): 520–527
The disability scale demonstrated excellent practicality and reliability. The scale accurately reflects patient perceptions regarding functional status and pain as well as doctor's global assessment and is responsive to change over long periods of time. We feel that this scale can be a valuable tool for the assessment of patients in future clinical trials and quality of care studies.
The McGill Pain Questionnaire: Major Properties and Scoring Methods
Pain 1975 (Sep); 1 (3): 277-299
The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically.
The Short-form McGill Pain Questionnaire
Pain 1987; 30 (2): 191-197
A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors.
Roland–Morris ~ in Wordor
as Adobe Acrobat
The Roland-Morris instrument was developed as an abbreviated SIP (sickness index profile) and is specific for low back pain, like the Revised Oswestry Disability Index. This questionnaire of 24 items can be administered in five minutes and has been validated in randomized trials of spinal manipulation. It was shown to be at least as reliable as the full SIP in cases of acute low back pain. It was found to be slightly more responsive to changes over time than the complete SIP. Compared to the Revised Oswestry Disability Index, the Roland-Morris instrument is also slightly more responsive to changes in acute to subacute low back pain. Thanks to the Illinois Chiropractic Society for putting this Adobe PDF file on line!
The Roland–Morris Questionnaire
There is an abbreviated 18 question low back QA here in this
article by Craig Liebenson...check it out!
The Bournemouth Back Questionnaire
Bournemouth Back Adobe Acrobat version. No scoring method is available on our website
The Bournemouth Questionnaire: A Short-form Comprehensive Outcome Measure. I. Psychometric Properties in Back Pain Patients
J Manipulative Physiol Ther 1999 (Oct); 22 (8): 503-510
Seven dimensions of the back pain model were included in the questionnaire. Having established face validity, the instrument was shown to demonstrate high internal consistency (Cronbach's ALPHA = 0.9) and good test-retest reliability (ICC = 0.95). All items were retained on the basis that they contributed to the overall score (item-corrected total score correlations) and to the instrument's responsiveness to clinical change (item change-corrected total change score correlations). The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures. The effect size of the instrument was high (1.29) and comparable with established measures.
Bournemouth Neck
Adobe Acrobat file (No scoring method is available on our website)
The Bournemouth Questionnaire: A Short-form Comprehensive Outcome Measure. II. Psychometric Properties in Neck Pain Patients
J Manipulative Physiol Ther 2002 (Mar); 25 (3): 141-148
The neck BQ covers the salient dimensions of the biopsychosocial model of pain, is quick and easy to complete, and has been shown to be reliable, valid, and responsive to clinically significant change in patients with nonspecific neck pain. Its use as an outcome measure in clinical trials and outcomes research is recommended.
The Questionnaire for Assessing Psychosocial Yellow Flags
The Outcome
Assessment Book Shelf
Please browse our Outcome Assessment book shelf. Any books you purchase will help to support our non-commercial website.
Measuring Functional Health Status in the Chiropractic Office Using Self-Report Questionnaires
Topics in Clinical Chiropractic 1994: 1 (1): 51-59 ~ FULL TEXT
The QA is located on page 81-83.
Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of impending change toward more closely managed health care purchasing, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economic and efficient way of accomplishing the task. Two such instruments are presented in detail: the Dartmouth COOP charts and the RAND 36-Item Health Survey 1.0, the latter of which is included in its entirety for use in the office setting. Several other instruments are briefly summarized.
The Neck Disability Index: A Study of Reliability and Validity
J Manipulative Physiol Ther 1991 (Sep); 14 (7): 409–415
Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number. A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI).While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.
Subjective and Objective Numerical Outcome Measure Assessment (SONOMA). A Combined Outcome Measure Tool: Findings on a Study of Reliability
J Manipulative Physiol Ther 2003 (Oct); 26 (8): 481–492
Function-based evaluation and treatment is the wave of the future for physical medicine and particularly for chiropractic for several reasons. First, function is quantifiable. Quantification of the patient-clinical picture promotes better evaluation. This leads to better application of diagnostic procedures and more specifically tailored treatment protocol. Quantification of function also allows us to more appropriately, adequately, and clearly communicate the patient-clinical picture to ourselves, to our patients, and to third parties.
Assessing the Clinical Significance of Change Scores Recorded on Subjective Outcome Measures
J Manipulative Physiol Ther 2004 (Jan); 27 (1): 26–35
To date, clinical trials have relied almost exclusively on the statistical significance of changes in scores from outcome measures in interpreting the effectiveness of treatment interventions. It is becoming increasingly important, however, to determine the clinical rather than statistical significance of these change scores.
The Possibility to Use Simple Validated Questionnaires to Predict Long-term Health Problems After Whiplash Injury
Spine 2004 (Feb 1); 29 (3): E47–51
The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.
Quantitative Functional Capacity Evaluation: The Missing Link to Outcomes Assessment
Topics in Clinical Chiropractic 1996; 3(1): 32-43 ~ FULL TEXT
In the quest of containing health care costs and still offering optimum care in terms of quality, the concepts of outcomes assessment of both subjective and objective varieties are discussed. Discussion of five criteria for the development of an instrument, and a discussion regarding high verses low tech functional testing, and utilization parameters with risk factors for chronicity are discussed.
Applying Outcomes Management into Clinical Practice
J. Neuromusculoskel. System 1997 (Summer) ; 5 (2): 1-14 ~ FULL TEXT
The paradigm shift in health care from case management to cost contained, outcomes management (OM) has vaulted the study and use of valid and reliable outcomes tools . OM, when used appropriately, can measure progress, or the lack thereof, in three critical areas which include pain management, physical capacity (impairment), and disability.
Proving the Existence of Chronic Pain
Steven G. Yeomans, D.C. ~ FULL TEXT
Pain is ultimately a subjective experience. Proving the existence of pain is therefore, not possible. In practice, when a patient reports pain, the patient is believed to have pain. Yet, not all pain is the same. There may be a variety of reasons for reporting pain to a physician---pain, drug seeking, psychological problems, litigation needs---but there is always a reason. The critical issue is how to untangle the other factors from pain, recognizing that these factors may drive pain and pain may drive these factors.
Outcomes Assessment: How to Satisfy the Insurance Industry with Time–Efficient Documentation
Craig Liebenson, D.C. and Steven G. Yeomans, D.C. ~ FULL TEXT
This article outlines a simple method for documenting the "medical nesessity" and outcomes of care. At one time or another, we have all found that the reimbursement of a patient's care was being denied. "Please provide documentation to demonstrate the necessity of your treatment" requests are now the norm for the practicing chiropractor. Every provider of every discipline is being held accountable for the care provided to a patient. Why? Because evidence–based treatment approaches are becoming an expected "standard" of proving the effectiveness of care over time, and because tracking outcomes is a means by which insurers decide if the care provided has been necessary.
The Relationship of Disability (Oswestry) and Pain Drawings to Functional Testing
European Spine Journal 2000; 9 (3): 208-212
The results of this study indicate that isokinetic test values are significantly influenced by a patient's self-reported disability and pain expression, which can be evaluated using simple tools such as pain drawings and the Oswestry questionnaire. This study supports the supposition that dynamometry testing is related to factors other than muscle performance.
The SCL–90–R in Clinical Application
The SCL-90-R is a 90-item self-report system inventory developed in the 1980s by Derogatis and designed to reflect the psychological symptom patterns of community, medical and psychiatric respondents. In the special application of CAD trauma and its aftermath, the SCL-90-R is particularly useful. It can validate or challenge the veracity of the patient's claims; it can be used to follow the patient's progress; and it can also be used as an outcome variable in clinical research.
Behavioral Responses to Examination: A Reappraisal of the Interpretation of "Nonorganic Signs"
Spine 1998 (Nov 1): 23 (21) ; 2367-2371
Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medico-legally.
Outcomes: The Key to the Future
Outcomes measurement will be a critical factor if the profession is to establish itself in the managed care market. This was echoed in a recent article in Topics, Clinical Chiropractic titled "Chiropractic Health Care: The Second Century Begins":
" ... chiropractic will be pushed by insurers, employers, workers' compensation programs, and managed care plans to demonstrate successful clinical outcomes using cost-efficient care methods."
Spinal Algometry in Clinical Practice
One drawback with palpation is that the examiner is unable to determine how much pressure is being applied. Terms like "mild," "moderate," or "strong" mean different things to different practicioners and patients. An instrument which is very useful in quantifying pressure is the algometer, also known as the pain threshold meter. This is a hand-held force gauge, fitted with a stylus and covered by a 1cm2 rubber tip. An analogue gauge is calibrated in kilograms/cm2, with a minimum reading of 1kg/cm2, and a maximum reading of 10kgs/cm2.
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