Chapter III: Outcome Assessment Measurement Devices

Chapter 3:
Outcome Assessment Measurement Devices


Pain is the primary complaint for 80% of all office visits to physicians each year in the U.S. [National Center for Health Statistics, 1986]. It is important to use the proper measurement device in order to get meaningful data of a patient’s baseline status. The measurement must then be reapplied to get meaningful data of a patient’s improvement. The testing device must be comprehensive enough to give a reliable clinical picture, simple to understand, easy to score, and able to be administered at a low cost.

The devices listed in bold are used very commonly within the chiropractic profession, and it is recommended that you become familiar with these outcome assessment devices. Unfortunately, copyright restrictions do not allow for the reproduction of these materials within these Wisconsin Chiropractic Association recommendations. Generally, you may access the original articles and use any of these devices in your office for the treatment of your individual patients.

A. General Health Questionnaires:

  1. Health Status Questionnaire v.2.0 [Health Outcomes Institute, 1993] 1
  2. SF-36 [Stewart, 1988; Interstudy, 1990] 2
  3. RAND 36 [RAND Corporation, 1986] 3
  4. Dartmouth COOP charts [Nelson, 1987] 4-6
  5. Sickness Impact Profile [Bergner, 1981] 7
  6. Nottingham Health Profile 8

B. Pain Questionnaires

  1. Visual Analog Scale [VAS] [Huskisson, 1982] 9-12
  2. Numerical pain scale [NPS] [Jenson, 1986] 13
  3. McGill/Melzak pain questionnaire [Melzack, 1975] 14
  4. Pain drawing [Mooney and Robertson, 1976] 15-16
  5. Pain Disability Index [Tait, 1987] 17
  6. Dallas Pain Questionnaire [Lawlis, 1989] 18-19

C. Disability: Lower Back Pain Questionnaires:

  1. Modified Oswestry Low Back Pain Questionnaire [Fairbank, 1980] 20-21
  2. Roland-Morris Disability Questionnaire ROL-SIP [Roland, 1983] 22
  3. Low Back Pain TyPE Specifications [Health Outcomes Institute, 1992] 23
  4. Million Disability Questionnaire [Million, 1982] 24
  5. Waddell Disability Index [Waddell and Main, 1984] 25

D. Disability: Cervical or Headache Questionnaires:

  1. Neck Disability Index [Vernon-Mior, 1991] 26
  2. Headache Disability Index: HDI [Jacobson, 1994] 27

E. Pychometrics Questionnaires:

  1. Psychosocial Pain Inventory [Heaton, 1980] 28
  2. Illness Behaviour Questionnaire [Pilowsky, 1976] 29
  3. Health Status Questionnaire 2.0 30 [Questions 37-39: depression screens]
  4. Waddell Non-Organic LBP signs [Waddell, 1980] 31
  5. Somatic Amplification Rating Scale [Korbon, 1987] 32
  6. Modified Zung Depression Index 33-34
  7. Modified Somatic Perception Questionnaire MSPQ [Main, 1983] 35
  8. Minnesota Multiphasic Personality Inventory [MMPI] 36-37
  9. Fear-Avoidance Beliefs Questionnaire FABQ [Waddell, 1993] 38
  10. Patient Satisfaction Questionnaire [Ware, 1983] 39
  11. GHAA Consumer Satisfaction Survey [Ware, 1991] 40
  12. Low Back Pain Patient Satisfaction [Deyo, 1986] 41
  13. Chiropractic Satisfaction Questionnaire [Coulter, 1994] 42


  1. Health Outcomes Institute. Health Status Questionnaire 2.0. Health Outcomes Institute, Bloomington, MN

  2. Interstudy: An introduction to Interstudy’s outcomes management system development plans. October, 1990. Interstudy, Excelsior, MN

  3. Rand 36-item health survey 1.0. Rand Health Sciences Program, Santa Monica, CA: RAND; 1986, 1992

  4. Johnson D. Dartmouth COOP Project. Hanover, NY: Dartmouth Medical School, 1989

  5. Nelson E, Berwick D. The measurement of heath status in clinical practice. Medical Care 1989;   27 (3):   S77

  6. Kraus N. The Dartmouth primary care cooperative ["COOP] information project. Interstudy Qual Edge 1991;   1:   33-39

  7. Bergner M, Bobbitt R, Carter R, Carter W, Gilson B: The sickness impact profile: Development and final revision of a health status measure. Medical Care 1981;   19 (80:   787

  8. Reviewed in: Deyo RA. Measuring the functional status of patients with lower back pain. Chiropractic Technique 1990;   2 (3):   127-137

  9. Huskisson S. Measurement of pain. J Rheumatol 1982;   9:   768

  10. Merskey H. The perception and measurement of pain, J Psychosom Res 1973;   17:   251-155

  11. Ventafridda V, DeConno F, DiTrapani P, Gallico S, Guarise G, Rigamonti G, and Tamurini M. A new method of pain quantification based on a weekly self-descriptive record of the intensity and duration of pain. In Bonica JJ, Lindblom U Iggo A eds: Advanceds in pain research and therapy, Vol 5: Proceedings of the Third World Congress on Pain.

  12. Jensen MP, Koroly P, O’Riordan EF, et al: The subjective experience of actual pain: an assessment of the utility of 10 indices. Clin J. Pain 1989;   5:   153

  13. Jensen M, Karoly P, Braver S. The measurement of clinical pain intensity: A comparison of six methods. Pain 1986;   27:   117

  14. Melzack R: The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;   1:   277

  15. Mooney V. Robertson J. The facet syndrome. Clin Orthop 1976;   115:   149

  16. Rainsford AO, Cairns D, Mooney V. The pain drawing as an aid to the psychologic evaluation of patients with lower back pain. Spine 1974;   1:   127-134

  17. Tait R, Pollard C Margolis R, Duckro P, Krause S. Pain disability index: psychometric and validity data. Arch Phys Med Rehabil 1987;   68:   438

  18. Review in: White A, Schofferman J. ed. Spine Care. Mosby, St. Louis, 1995. P. 919-922

  19. Lawlis GF, Cuencas R, Selby D, et al. The development of the Dallas Pain Questionnaire for illness behaviour. Spine 1989;   14:   511

  20. Fairbanks J, Davies J, Couper J, O’Brien J. The Oswestry low-back pain disability questionnaire. Physiotherapy 1980;   66:   271

  21. Hudson-Cook N, Tomes-Nicholson K, Breen A. The revised Oswestry low back pain questionnaire. Thesis, Anglo-European College of Chiropractic, 1988

  22. Roland M, Morris R. Study of natural history of back pain, part I: development of a reliable and sensitive measure of disability in low back pain. Spine 1983;   8:   141

  23. Health Outcomes Institute. Low Back Pain TyPE Specifications. Health Outcomes Institute, Bloomington, MN

  24. Million R, Nilsen K, Jayson MIV, et al. Evaluation of lower back pain and assessment of lumber corsets with and without back supports. Ann Rheum Dis 1981;   40:   449

  25. Waddell G, Main C: Assessment of severity in low-back disorders. Spine 1984;   9:   204

  26. Vernon H, Mior S.
    The Neck Disability Index: A Study of Reliability and Validity
    J Manipulative Physiol Ther 1991 (Sep); 14 (7): 409–415

  27. Jacobson GP, Ramadan NM et al. The Henry Ford Hospital Headache Disability Inventory [HDI]. Neurology 1994;   44:   837-842

  28. Heaton RK, Lehman RAW, Getto CJ. Psychosocial Pain Inventory, Odessa, FL, 1980, Psychological Assessment Resources

  29. Pilowsky, I, Spence ND. Illness behaviour syndromes associated with intractable pain. Pain 1976:   2:   61-71

  30. Health Outcomes Institute. Health Status Questionnaire 2.0. Health Outcomes Institute, Bloomington, MN

  31. Waddell G, McCulloch J, Kummel E, Venner R. Non-organic signs in low back pain. Spine 1980:   5:   117

  32. Korbon GA, DeGood E, Schroeder ME, et al. The development of a somatic amplification scale for lower back pain. Spine 1987;   12 (8):   787-791

  33. Zung W. A self-rating depression scale. Arch Gen Psychiatry 1965;   32:   63-70

  34. Review in: Ahles TA, Yunus MB, Mari AT. Is chronic pain a variant of depressive disease? The case of primary fibromyalgia syndrome. Pain 1987;   29:   105-111

  35. Main C. 1983 Modified somatic perception questionnaire. J. Psychosom Res 1983;   27:   503-514

  36. Hanvik LJ. MMPI Profiles in patients with lower back pain. J. Consul Psychol 1951:   15:   350-353

  37. Hathaway SR, McKinley JC. Minnesota Multiphasic Personality Inventory: manual for administation and scoring. Psychological Corporation, New York, 1967

  38. Waddell G, Newton M, Henderson I, et al. A fear-avoidance beliefs [FABQ] questionnaireand the role of fear avoidance beliefs in chronic low back pain and disability. Pain 1993:   52:   157-168

  39. Ware J, Davies AR. Defining and measuring patient satisfaction with medical care. Eval and Program Plan 1983;   6:   247-263

  40. Davies AR, Ware JE. GHAA’s consumer satisfaction survey and user’s manual. 2nd ed. Washington, DC: GHAA: 1991

  41. Deyo R, Diehl A. Patient satisfaction with medical care for low back pain. Spine 1986:   11:   28

  42. Coulter I, Hays R, Danielson C. The chiropractic satisfaction questionnaire. Topic in Clin Chiropractic 1994;   1 [4]:   40-43

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