Roland‐Morris Disability Questionnaire

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Online Course: General Assessment Considerations for Children with Pain Skip to content Search Why Plus? Courses Features Features Exercises & Telehealth Books & Journals Anatomy Videos Podcasts Quizzes Webinars Forum Certificates CPD & CEUs Join For Teams For Teams Clinics & Hospitals Universities & Colleges Organisations Help Login Try For Free Online Course General Assessment Considerations for Children with Pain Effectively evaluate chronic pain in children and address imbalances in the four pillars of health Start course 1.5-2 hours - - - - Powered by Physiopedia Course instructor Tracy Prowse Tracy is a child and adolescent health physiotherapist, mindfulness teacher, pain practitioner, lecturer and trainer Course instructor ReLAB-HS Learning, Acting and Building for Rehabilitation in Health Systems Summarising Summarising the latest research & evidence Trusted Trusted by over - clinicians Learn Learn anytime, anywhere, on any device Accredited Accredited certificate of completion Introduction Introduction: Assessment and Questionnaires Subscribe to Plus to continue this course Join Plus Accreditations Select a country (and if appropriate state) to view information about this course's accreditation and/or acceptance in this jurisdiction. 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Training 5 or more? Get your team access to ALL courses plus exercise prescription & telehealth. Try Plus for teams Introduction Chronic pain can significantly impact a child's life, affecting both mental and physical health. Maintaining a balance between the four pillars of health (stress, sleep, diet and exercise) is important for a child's well-being. When working with paediatric patients, it is necessary to understand and then evaluate the impact that these pillars can have on chronic pain. If these pillars are not balanced, a child may have increased sensitivity to pain. To fully assess and manage chronic pain in children, clinicians must also gain insight into a child's perception of pain. Using self-reported assessments and questionnaires can help initiate dialogue between the clinician and child about pain. This course will explore pain questionnaires useful for children who have chronic pain. It will then discuss potential strategies to address any imbalance in the four pillars of health that may be impacting a child's ability to manage pain. Aims This course aims to explore the four pillars of health and introduce assessment tools for paediatric chronic pain. Outline This course is made up of videos, reading, forum posts and a final quiz. The course content is split into the following sections: Video Reading activity Video Reading activity Quiz Target audience This course is aimed at rehabilitation professionals, students and assistants including but not limited to Physiotherapists, Occupational Therapists, Speech and Language Therapists, Rehabilitation Doctors, Rehabilitation Nurses, Prosthetists, Orthotists, Psychologists, Audiologists, Dietetics, Social Workers. Community Health Workers, Nurses or Medical Doctors interested in this subject are also invited to participate. More info Practicalities Hours of Learning - No deadlines are applied to this course and it can be started and completed in your own time according to your personal schedule. We expect the required elements to take around 1.5-2 hours depending on your schedule and learning style. Additionally there are many optional resources provided and if you choose to review these the course could take longer to complete. Types of Activities - Reading Physiopedia pages, journal articles, book chapters. Watching videos. Attempting quizzes. Participating in an international discussion forum. Certificates - At the end of the course, when you have completed all of the required elements, you will be able to download a certificate of completion and 1.3 Plus points will be added to your personalised learning dashboard. Requirements to complete this course In order to complete this course and receive a course completion certificate plus CEUs/CCUs/CPD points you will need to: Respect the Plus Community Culture. Log all the required learning activities as complete (represented by the orange icons!). Actively and appropriately participate in the course discussions. Pass a final quiz with a score of 80% or more. Complete a course evaluation form. Learning outcomes At the end of this course you will be able to: discuss at least five assessment tools that can be used for children who have chronic pain identify four factors that can shape a child’s pain experience discuss how the four pillars of health can influence pain in children Related courses You might be interested in More info. Academic Readiness and Developmental Disabilities in Early and Middle Childhood Development 2-2.5 hours 139 Presented by Tracy Prowse & ReLAB-HS More info. Assessment and Exercise Interventions in Early and Middle Childhood Development 1-1.5 hours 295 Presented by Tracy Prowse & ReLAB-HS More info. Benign Joint Hypermobility Syndrome 1-1.5 hours 383 Presented by Tracy Prowse & Paediatrics Physiotherapy Group of the SASP More info. Developing Physically Active and Sporty Kids – Benefits and Barriers 1-1.5 hours 116 Presented by Tracy Prowse & ReLAB-HS More info. Developing Physically Active and Sporty Kids – Injuries Specific to Children and Teenagers 1-1.5 hours 118 Presented by Tracy Prowse & ReLAB-HS More info. Developing Physically Active and Sporty Kids – Overuse Injuries and Burnout 1-1.5 hours 137 Presented by Tracy Prowse & ReLAB-HS More info. General Assessment Considerations for Children with Pain 1.5-2 hours 142 Presented by Tracy Prowse & ReLAB-HS More info. General Management of Paediatric Pain Problems 1.5-2 hours 124 Presented by Tracy Prowse & ReLAB-HS More info. 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Objective[edit | edit source]

First published in 1983 and reviewed in 2000, the Roland-Morris Disability Questionnaire[1] (RMDQ) is designed to assess self-rated physical disability caused by low back pain. [2]

Intended Population[edit | edit source]

The Roland-Morris Disability Questionnaire is most sensitive for patients with mild to moderate disability due to acute, sub-acute, or chronic low back pain. 0The Sickness Impact Profile (SIP), a 136-item health status assessment spanning all facets of physical and mental function, served as the foundation for the Roland-Morris Disability Questionnaire. The original authors chose 24 elements from the SIP because they were explicitly relevant to bodily processes that low back pain was expected to influence.
For patients with severe disability the Oswestry Disability Indexis recommended. [3]

Method of Use and Scoring Interpretation[edit | edit source]

There are different questionnaires available, which differ from each other in the number of statements: 24-, 18- and 11-item questionnaires. It has also been adapted across cultures and translated for use in different countries.

The patient is asked to tick a statement when it applies to him that specific day, this makes it possible to follow changes in time. The end score is the sum of the ticked boxes. The score ranges from 0 (no disability) to 24 (max. disability) depending on the questionnaire used. [2] Roland and Morris omitted describing the various levels of disability (for example, 40%–60% of disability is severe). Based on the study of serial questionnaire scores, clinical changes over time can be rated. We would calculate an 80% improvement (12/15 x 100) if, for instance, a patient had a score of 15 at the start of therapy and a score of 3 at the end (12 points of improvement)[4].

[5]

Questions[edit | edit source]

It can be administered face-to-face, electronically, or over the phone. There are questionnaires in different languages, available online for free for clinicians to use via the website of the Roland Morris Disability Questionnaire.

  1. I stay at home most of the time because of my back.
  2. I change position frequently to try and get my back comfortable.
  3. I walk more slowly than usual because of my back.
  4. Because of my back I am not doing any of the jobs that I usually do around the house.
  5. Because of my back, I use a handrail to get upstairs.
  6. Because of my back, I lie down to rest more often.
  7. Because of my back, I have to hold on to something to get out of an easy chair.
  8. Because of my back, I try to get other people to do things for me.
  9. I get dressed more slowly than usual because of my back.
  10. I only stand for short periods of time because of my back.
  11. Because of my back, I try not to bend or kneel down.
  12. I find it difficult to get out of a chair because of my back.
  13. My back is painful almost all the time.
  14. I find it difficult to turn over in bed because of my back.
  15. My appetite is not very good because of my back pain.
  16. I have trouble putting on my socks (or stockings) because of the pain in my back.
  17. I only walk short distances because of my back.
  18. I sleep less well because of my back.
  19. Because of my back pain, I get dressed with help from someone else.
  20. I sit down for most of the day because of my back.
  21. I avoid heavy jobs around the house because of my back.
  22. Because of my back pain, I am more irritable and bad tempered with people than usual.
  23. Because of my back, I go upstairs more slowly than usual.
  24. I stay in bed most of the time because of my back.

Reliability[edit | edit source]

Macedo et al. (2011) looked at the results from different studies for the reliability of the 24-, 18- and 11-item RMDQ: [6]

  • Test-retest reliability 24-item: intraclass correlation (ICC) ranges from 0.42 – 0.91
  • Test-retest reliability 18-item Stratford: ICC ranges from 0.68 – 0.75
  • Test-retest reliability 11-item: ICC ranges from 0.89

Validity[edit | edit source]

Content validity:

  • The RMDQ is limited as it only covers specific physical problems, not psychological or social ones. In case these problems should be investigated as well, other measuring of these functions is advised.[2]

Construct validity:[2]

  • Construct validity defines the degree to which the test measures the variables it is supposed to measure.

The RMDQ correlates well with other tests which measure physical disability:

  • Physical subscales of SF-36
  • Physical subscales of Sickness Impact Profile
  • Quebec Low Back Scale
  • Oswestry Disability Questionnaire
  • Pain ratings

Responsiveness[edit | edit source]

Internal responsiveness:[6]

  • Internal responsiveness shows the ability of a test to measure differences in time.
  • Using effect sizes:
    • 24-item: ranges from 0.63-0.71
    • 18-item Stratford: ranges from 0.73-0.82
    • 11-item: ranges from 0.61-0.69

External responsiveness:[6]

  • External responsiveness gives the relation between the results measured with RMDQ and the results measured with the Global Perceived Effect Scale (GPE scale)
  • Pearson correlation with GPE Scale:
    • 24-item: ranges from 0.45-0.54
    • 18-item Stratford: ranges from 0.44-0.53
    • 11-item: ranges from 0.39-0.49

Resources[edit | edit source]

Related articles
The Effects of Walking on Low Back Pain - Physiopedia Introduction Low back pain (LBP) that is not associated with serious or potentially serious causes has been described in the literature as 'non-specific', 'mechanical', 'musculoskeletal', or 'simple' LBP.[1] Non-specific LBP is defined as LBP not attributable to a recognisable specific pathology (eg, infection, tumor, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome).[2] LBP between the rib cage and gluteal folds LBP can be further split into three categories; acute, sub-acute, and chronic.[3] Acute is anything that persists for less than 6 weeks. Sub-acute is anything persisting between 6-12 weeks. Chronic is anything persisting for 12 weeks or more. LBP is commonly described to be between the anatomical regions of the ribs and gluteal folds.[4] Anatomy[edit | edit source] The lumbar spine comprises the lower end of the spinal column between the last thoracic vertebra (T12) and the first sacral vertebra (S1). There is a total of five lumbar vertebrae (L1-L5) that are much larger compared to other regions within the vertebral column. These large facets help support the upper body, as they absorb axial forces (against gravity) delivered from the head, neck, and trunk, and provide protection for the spinal cord from the canal that is formed. The lumbar spine allows for diverse types of trunk motion, including flexion, extension, rotation, and side bending, thus providing further reasons as to why the facets are much larger. Each lumbar segment consists of multiple components; vertebral body, transverse process, super articular process, super articular facet, intervertebral disc, vertebral forearm, the pedicle of the vertebral arch, lamina of the vertebral arch, and a spinous process.[5] Due to the complex structure of spinal components, discs, intervertebral joints, muscles, and nerves, LBP can present with the same symptoms from different causes. Epidemiology[edit | edit source] LBP causes more disability than any other condition, affecting 1 in 10 people and becoming more common with increasing age, [1]with rates of 1%–6% in children aged 7–10 years, 18% in adolescents, and a peak prevalence ranging from 28% to 42% in people between 40 years and 69 years.[6] The prevalence of LBP is thought to be increasing due to an increasing and aging population [7] with estimates of life time prevalence being as high as 84% in the adult population. [8] The age-specific point prevalence of low back pain in 2017, by gender.[9] One study that was carried out in 195 countries assessing the incidence, prevalence, and years lived with disability for 354 medical conditions found LBP to be the leading cause of worldwide productivity loss as measured in years, and the top cause of years lived with disability in 126 countries.[6] In the United Kingdom (UK), it is estimated that LBP is responsible for 37% of all chronic pain in men and 44% in women and the total cost of LBP to the UK economy is reckoned to be over £12 billion per year. [1] Risk factors for LBP are age, sex, height, weight, sedentary lifestyle, depression, anxiety, insomnia, and smoking.[10] Although muscle strain and imbalance, ligament sprain, and soft tissue damage account for almost all LBP, as it is non-specific, it often has no identifiable underlying condition or origin. [11] Office workers are usually required to sit for long hours working on a computer while spending most of their time in a sitting position. Approximately 34%- 51% of office workers experienced LBP in the preceding 12 months. Occupational groups exposed to 'poor postures' while sitting for longer than half a day have a considerably increased risk of experiencing LBP. Subjects with LBP are likely to be in sustained postures and have large and infrequent spinal movements. Prolonged postural loading of the spine while sitting can reduce joint lubrication, fluid content of intervertebral discs, and increased stiffness. Additionally to this, prolonged muscle activation in static sitting may lead to localised muscle tension, muscle strains, muscle fatigue, and other soft-tissue damage, causing impairment of motor coordination and control as well as increased mechanical stress on ligaments and intervertebral discs.[12] Prevalence of walking in the United Kingdom: People made an average of 236 walking trips and walked an average of 220 miles. People on average have walked less than in 2019, following a fall in short walks. People walked 7% farther in 2020 compared to 2019. 67% of adults in England reported walking at least once a week. 92% of local authorities had at least 60% of their adult population walking at least once a week. The NHS provides a guide on 'walking for health', to help motivate the population and help them meet the recommended minimum moderate activity guidelines of 150 minutes. Pedometer Driven Walking[edit | edit source] Example of a pedometer Pedometers are devices that work by counting the steps someone takes to estimate the distance they have traveled. [13] Pedometers are usually worn at the hip (on the waistband of clothing) and in alignment with the patella although this may not be the case for all pedometers. There are also other ways of tracking steps - many people now have fitness trackers which are attached to the wrist and will also have the ability to count steps. Instructions will be included with pedometer devices, and as there are many different types it is important to check these before usage to ensure that the pedometer is being used as accurately as possible. Some pedometers may also be more complex and do a little bit more than just counting steps such as showing calories burned, activity times, and memory logs. Whilst not a pedometer in the traditional sense, the NHS (National Health Service) also has an application which is free to download called 'Active 10' - this is designed to track walking and will indicate the total amount walked and how much of that was brisk walking. Within the app, there are also options to set goals, achieve milestones, and view progress over the weeks and months. So a pedometer is not the only option to keep a track of walking and daily activity - there are many more apps out there that will do the same thing! Using an app as a pedometer or walking tracker does rely on the individual having a mobile phone and keeping it in their pocket to ensure it tracks all activity whereas a standard pedometer can be used by a wider number of people and may not be as complex. Do Pedometers Increase Physical Activity?[edit | edit source] The NICE (National Institute for Health and Care Excellence) guidelines on LBP and sciatica in over 16s - published in 2016 and last updated in 2020 - advises self-management and exercise as treatments. [1]A pedometer would be an easy way of giving someone a tool to help self-manage their activity levels, as long as this was an appropriate choice of exercise for the individual - those with LBP should be encouraged to continue with their regular activities as well. [1] A three-arm cluster, randomised control trial (RCT) conducted in 2016 with an eventual number of participants at 956 recruited from primary care settings, found that a pedometer-based walking intervention (regardless of whether there was nurse support) increased the step count and physical activity of generally inactive 45-75 year old at a 12 month follow up. [14]A meta-analysis in 2009 of pedometer-based interventions for activity conducted in 2013 included 32 studies and found using pedometers to have a positive effect on physical activity and this was regardless of age or intervention length.[15] The studies had varying interventions from keeping a daily log of steps, completing 10,000 steps, individualized goals, or a combination of strategies.[15] Do Pedometers Affect LBP?[edit | edit source] Acute Low Back Pain (ALBP)[edit | edit source] There is arguably less research in relation to ALBP and the effects of using a pedometer. However, a study in 2015, focusing on those with ALBP of 48 hours or less looked at whether 'stay active' advice or 'adjusting activities to pain' had different effects. [16] Participants were aged between 18 and 65 and all were provided with a pedometer to track daily steps with the instruction of wearing it at all times during waking hours, they found the pedometer an easily used intervention which increased physical activity, particularly in those with the advice to 'stay active'.[16] This study shows that pedometers could have a useful place in treatment alongside other advice and management techniques for those with ALBP despite the study being over a short period of time, and the study size is relatively small. Chronic Low Back Pain (CLBP)[edit | edit source] As previously mentioned, CLBP accounts for a significant amount of chronic pain in individuals of the UK, so interventions that aid in the treatment and management would be beneficial. A recent RCT published in 2021, looked at the effects of a pedometer-driven individualized walking plan compared to standardised care in increasing completion and adherence of physical activity in CLBP management.[17]Whilst no significant difference was noted in disability or pain, there was an indication that using an individualised, guided pedometer program aided in adherence and participation of physical activity - although relevant measures such as step count were not taken from the standardised care group, so it is unclear if there were any increases in physical activity amongst them.[17] A previous RCT from 2013, of an internet-based pedometer intervention, did find that in the short-term of 6 months back pain disability had decreased, but at 12 months there was no difference between the group with access to the internet support and the ones utilising the pedometer and standard management only.[18]Again, this shows, that whilst pedometer-driven walking can have positive effects in physical activity and adherence, there may need to be further research to explore how positive outcomes can be gained in the long term. It seems that pedometers can be a relatively cheap and accessibly form of intervention and management in individuals with LBP, and this can have greater positive impacts when included with support in one form or another.[16] Benefits of Walking on Low Back Pain[edit | edit source] The lower back muscles play an important role in maintaining its stability and movement; two key aspects that are needed when walking. [19] These muscles can become deconditioned in those with sedentary lifestyles, leading to weakness over time. This prolonged weakness can increase muscular fatigue, and injury, exaggerating the pain already being experienced. [19] Reduced physical activity can also cause these muscles and the joints of the lumbar spine to become stiff, which can increase the pressure on the lower back. [20] Walking has many positive impacts on the lower back, which can prevent or reduce these changes occurring in the following ways: Increased blood flow: Small blood vessels and capillaries in the lower back muscles can become constricted following decreased physical activity, reducing the blood flow to these muscles. Walking allows for more movement in these muscles, allowing these capillaries and blood vessels to open up again. This, in turn, increases the blood supply and nutrients to these muscles, improving muscular health and strength and aiding with the healing process. [20] Stretch and contraction of muscles: The movement in the lower back during walking increases the stretch and contraction of the lower back muscles and those in the legs, buttocks, and core, allowing for more flexibility and mobility in this area. This flexibility increases the overall range of motion in the lower back, also improving the health and strength of the lower back muscles. [21] Treatment and Management[edit | edit source] Effect Of Walking On LBP[edit | edit source] Current evidence supports the use of walking as a treatment option for LBP. A cross-sectional study from 2017 evaluating the relationship between walking and LBP, consisting of 5,982 adults, found that walking was associated with a reduced risk of LBP. [22] The authors also found that the presence of LBP was proportionate to walking frequency, with those who walked more often having reduced LBP. These results are supported by those of a systematic review from 2019 evaluating the effects of walking on those with chronic LBP. [23] Walking was found to be as effective as other non-pharmacological interventions on pain and disability in short-term (<3 months) and intermediate (3-12 months) follow-ups. These findings allowed for walking to be recommended for managing and treating LBP. [23] The effects of walking have been compared to the effects of exercise for LBP. A systematic review from 2019 comparing the two concluded that walking was as effective as exercise for improving pain, disability, quality of life, and fear-avoidance in those with chronic LBP. [24] Much like the studies by Kim et al. [22] and Sitthipornvorakul et al. [23], Vanti et al. [24] recommend the use of walking as a treatment and management option for LBP. Interestingly, a systematic review from 2022, found that people with LBP have altered gait patterns compared with healthy individuals. [25] Those with LBP were found to walk slower, have reduced stride lengths, greater lumbar paraspinal activation, and reduced thorax/pelvic coordination. [25] However, the authors were unable to report if these changes were adaptive or maladaptive. Overall, these results indicate that gait re-education may be needed for those with LBP to gain the most benefits from walking. A systematic review in 2015 included seven randomised controlled trials involving 869 participants adults with chronic LBP. It compared walking to other non-pharmacological management methods such as usual care, specific strength exercises, medical exercise therapy, or supervised exercise classes. It suggested that walking is the same effective as other management methods while having a lower cost. [26]. It could be explained by its high accessibility, but does not require training, supervision, or specialised equipment. [26] Other research supported that walking is as effective as conventional physiotherapy treatment such as lumbar stabilisation and muscle strengthening exercise. [27][28] A randomised control trial included 48 participants comparing the effect of lumbar stabilisation exercise and walking exercise on LBP. It suggested both interventions significantly reduced LBP, and both interventions show similar results.[28] Another randomised control trial compare strengthening exercise to a combined programme of strengthening exercise and walking exercise on chronic LBP. It suggested that both interventions were beneficial but combined exercise programme was more effective for reducing pain levels than the strength exercise. [27]Another randomised control trial also supported 44 participants comparing conventional physiotherapy to a combination of conventional physiotherapy with walking exercise. It suggested that a combination of conventional physiotherapy with walking exercise is more effective to reduces pain and kinesiophobia, and improved function in patients with subacute and chronic non-specific LBP. [29] How to Use Walking as a Treatment for LBP[edit | edit source] 1. Combine with conventional physiotherapy treatment[edit | edit source] Walking is a low-cost intervention, and a combination of physiotherapy with walking is more effective than conventional physiotherapy alone. [26][27][29] Walking exercise could be educated by physiotherapists alongside their exercise prescription. Recommendations support the use of exercise for at least 15 to 30 minutes most days for those with LBP. [30] This can mean gradually building up walking distance and capacity to reduce the risk of injury and allow for the body to adapt to the changes. 2. Goal setting[edit | edit source] The use of a pedometer means that the patient is able to manage and keep track of their steps whilst walking. The patient might be advised to keep an "activity diary" which keeps track of a daily step count and the patient's step goal. This is achieved by calculating the patient's average step count in the first week of activity, and using this as a baseline when deciding a step goal for the second week. [31] The use of an activity diary can also help establish the patients' baseline in the first week, which is important in informing their individual goals for rehabilitation. [31] For example, use pedometer/tracking apps (like Active 10) to monitor and then set weekly targets (increase by a certain amount each week/two weeks for example). 3. Postural Control[edit | edit source] Having the correct walking posture is important to allow for more comfortable walking, helping to reduce pain and discomfort. An optimal posture can be achieved using multiple strategies: Stand up straight: This can be achieved by making yourself as tall as possible, without leaning forwards or backward. Ensuring your chin is kept up and your eyes facing forwards allows for reduced strain on your neck and back. These together will allow for a better posture and improved balance. [32] Keep shoulders back and relaxed: Relaxing your shoulders helps relieve tension and allows for a more neutral spine when walking. Engage core muscles and keep a neutral pelvis: engaging your core and keeping a neutral pelvis prevents arching of the spine and tilting of the pelvis, allowing for a more neutral spine and better posture. [33] Outcome measures[edit | edit source] There are a variety of outcome measures that might be used when advising walking as a management strategy for patients with LBP. These might look at: Pain Disability Physical activity Pain[edit | edit source] Visual Analogue Scale (VAS)[edit | edit source] The VAS (Visual Analogue Scale) is one of the most common outcome measures for LBP. [34] It is an example of a subjective PROM (Patient Reported Outcome Measure), where the patient records their pain on a 100mm line- from "no pain" at the beginning to the "worst pain imaginable". Some types of VAS also use faces to represent pain from "mild", "moderate" to "severe", as shown below. Examples of a VAS [35] Previous studies have found that the VAS is a "reliable and valid" outcome measure for use in a LBP population. [36] It has also shown reliability in predicting disability due to LBP. [37] Disability[edit | edit source] Roland-Morris Disability Questionnaire (RMDQ)[edit | edit source] The Roland-Morris Disability questionnaire (RMDQ) is a commonly used PROM, designed to assess a patient's disability in relation to their LBP. It is a 24-item questionnaire that looks at physical functions that the patient feels have been affected, and a higher score represents a higher level of disability due to LBP. [38] An example of the RMDQ [39] A study from 2020 found that the RMDQ had good test-retest reliability and internal consistency reliability in capturing the "everyday functional impact of low back pain". [40] Oswestry Disability Index (ODI)[edit | edit source] The Oswestry Disability Index (ODI) is also commonly used to assess functional disability in patients with LBP. [41] It consists of 10 items which are detailed below, as well as the interpretation of the scores. Oswestry Disability Index (ODI) [42] Interpretation of ODI scores [43] The ODI has been found to be a "valid and reliable scale suitable for measurement of disability for low back pain", and in particular showing high test-retest reliability. [44] A study looked at comparing the ODI and the RMDQ to each other. The study found that the ODI appeared to be better at detecting changes in patients with more severe lower back pain, whereas the RMDQ seemed to have an advantage when measuring patients who had more mild disability.[45] Physical activity[edit | edit source] International Physical Activity Questionnaire (IPAQ)[edit | edit source] The International Physical Activity Questionnaire (IPAQ) is formed of two different versions including the IPAQ short-form and the IPAQ long version. Both versions require the patient to recall their physical activity levels in the past 7 days. Based on these scores, they are placed in one of three categories: low activity levels, moderate activity levels, and high activity levels. [46] The IPAQ short-form consists of 4 categories where the patient reports how much they participated in the following activities in the past 7 days: Moderate activity Vigorous activity Time spent walking Time spent sitting The IPAQ short-form may be more beneficial for use in a clinical setting due to the shorter/more accessible nature of the questionnaire for patients. [47] The IPAQ long version assesses physical activity across 5 domains: Job-related physical activity Transportation physical activity Housework, house maintenance, and caring for family Recreation, sport, and leisure time Time spent walking The IPAQ long version is typically used in research studies or may be used if a more detailed picture of a patient's physical activity levels is preferred. [47] Overall, the IPAQ has been subject to extensive reliability and validity testing across 12 different countries (14 sites) from 2000 as an outcome measure for physical activity. Suggestions for Future Clinical Research[edit | edit source] Based on the current literature, walking has been shown to be an effective management strategy for patients with LBP. However, more high-quality RCT’s need to be carried out using a variety of outcome measures, including physical activity, to further investigate walking as an effective management strategy for LBP.   In order to strengthen the current evidence around this topic, further research could be carried out on how to ensure the long term effects of pedometer-based intervention. It would also be valuable to investigate whether added interventions might be necessary in aiding supportive positive outcomes long-term. The current NICE guidelines for LBP and sciatica were published in 2016 and updated in 2020 for pharmacological interventions. However, the advice for “non-pharmacological interventions” last had an evidence review in 2016. Therefore, it may be beneficial for a reassessment based on new evidence, in which guidelines around walking could be evaluated. Oswestry Disability Index - Physiopedia Objective Patient-completed questionnaire which gives a subjective percentage score of level of function (disability) in activities of daily living in those rehabilitating from low back pain. Oswestry Low Back Pain Disability Questionnaire Intended Population[edit | edit source] Acute or chronic low back pain.  Most effective for persistent severe disability while the Roland-Morris is better for mild to moderate disability[1] Method of Use[edit | edit source] Questionnaire examines percthe eived level of disability in 10 everyday activities of daily living. Pain intensity Personal care Lifting Walking Sitting Standing Sleeping Sex (if applicable) Social Travel Each item consist of 6 statements which are scored from 0 to 5. With 0 indicating the least disability and 5 the greatest. From Paper Based to Electronic Patient Record Systems[edit | edit source] Conventionally ODI is applied as paper based forms. By development of internet technologies, online calculator tools for ODI become popular. Electronic patient record (EPR) systems are specialised databases for management on patient's health records. By the integration of EPR and outcome measure databases distance patient assessment can be possible.  In 2007 Irmak and Ergun has developed experimental tool for integration of EPR and online assessment system for ODI and rolland Morris Questionnaire by using different programming languages and databases; PHP-Mysql, C# Javascript, and MS Access. Currently this system is available for online calculation and assessment for non registered users. For scientists a distance patient assessment interface is also available. The ODI was originally developed in English but has now been translated into over 40 languages. Evidence[edit | edit source] Research has concluded that the ODI is a valid, reliable and responsive clinical tool when used to determine the level of function (disability) associated with low back pain.[2] Reliability[edit | edit source] The ODI addresses a broader concept of disability than that directly related to pain intensity[3]. Test-retest reliability has been shown to be high, a study by Fairbank et al[4] recorded values ranging from = 0.83 to 0.99 that can vary over a given period of time. Validity[edit | edit source] In a study 1997 by Fisher K, Johnston M it was concluded that the measure had good face validity, where patients found it relevant with none of them refusing to complete it. However, they found there were moderately clear relationships between reported ability on walking and sitting and the actual measured performance on these activities, although lifting was not as well validated[5]. In a more recent study by Vianin in 2008 the ODI construct validity was tested and it found that compared to other outcome measures that measure disability due to low back pain, the ODI was found to be consistent with them. This shows that the ODI is a valid measure of disability due to low back pain[2]. Responsiveness[edit | edit source] In a study by Walsh et al did not find that there was a significant benefit of using condition-specific outcome measures. However, they did report that the ODI has been found to have a greater responsiveness when comparing the measurement of function over pain.[6] Miscellaneous[edit | edit source] Bolton JE, Fish RG (1997) Responsiveness of the Revised Oswestry Disability Questionnaire Eur J Chiropractic 45, 1, 9-14 Hudson-Cook N, Tomes-Nicholson K, Breen AA (1989) Revised Oswestry disability questionnaire In Roland MO, Jenner JR, eds (1989) Back pain: new approaches to rehabilitation and education New York NY Manchester University Press 187ñ204. McDowell I, Newell C (1996) Measuring Health ñ a guide to rating scales and questionnaires Oxford University Press ISBN 0-19-510371-8. Deyo RA, Andersson G, Bombardier C (1994) Outcomes measures for studying patients with low back pain Spine 19, 185, 2032S-2036S. Beattie P, Maher C (1997) The role of functional status questionnaires for low back pain Australian Journal of Physiotherapy 43, 1, 29-38. LeClaure R, Bher F et al (1997) A cross sectional study comparing the Oswestry and Roland Morris functional disability scales in two populations of patients with low back pain at different levels of severity Spine 22, 1, 68-71 Davidson M & Keating J (2001) A comparison of five low back disability questionnaires: reliability and↵responsiveness. Physical Therapy 2002;82:8-24.[7] Resources[edit | edit source] More information on the use of the Oswestry Disability Index. Baker D, Pynsent PB, Fairbank JCT (1989) The Oswestry disability index revisited: its reliability, repeatability, and validity, and a comparison with St Thomas Disability Index. In Roland MO, Jenner JR eds (1989) Back Pain: new approaches to rehabilitation and education. New York, NY. Manchester University Press 174-186 Fairbank J, Couper J, Davies J, O'Brian J. The Oswestry low backpain questionnaire, Physiotherapy 1980;66:271-3. (Version 1.0)[4] Fairbank J, Pynsent P. The Oswestry disablility index. Spine 2000;25:2490-53. (Version 2.0)[8] Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 2000;25:3115-3124 (Version 2.1)[9] Quebec Back Pain Disability Scale - Physiopedia Objective  The Quebec back pain disability scale (QBPDS) is a condition-specific questionnaire developed to measure the level of functional disability for patients with low back pain (LBP) that was designed, developed, and validated by Kopec et al in 1995. [1] Original versions of the scale were developed in French and English and were reported to meet the most stringent criteria for a health assessment instrument. Investigators and qualified colleagues translated the English version of the QBPDS into Dutch, Iranian, Brazilian Portuguese, Turkish, Chinese, Greek, Polish, Korean, and Arabic. [2] [3] The original purpose of the questionnaire is to take into account the functional limitations related to pain, to monitor the progress of individual patients and to compare the evolution of LBP subjects incorporated in rehabilitation programs. [4] [2] [5] The Quebec back pain disability scale consists of 20 daily activities that can be categorized into 6 types of activities: [1] [2] Bed/rest items                                      1–3 Sitting/standing items                           4–6 Ambulation items                                  7–9 Movement items                                   10–12 Bending/stooping items                         13–16 Handling of large/heavy objects items    17–20. The various components of the questionnaire were selected from a larger pool of items based on test-retest reliability, item-total correlations, and responsiveness of individual items and by using techniques of factor analysis and item response theory. [1] The scale exists of one central question: “Do you have trouble today with...?” followed by 20 activities of daily life. Some examples of daily activity: taking something out of the fridge, getting out of bed... In every activity, there are 6 answer categories, measured by using a Likert scale from 0-5 (0 = no effort, 5 = not able to). If the patient suffers a lot that day, he scores that activity with a 5, if it gives no problems a 0. [1] [4] [3]  The final outcome is obtained by the sum of the scoring of the degree of difficulty in performing the 20 daily activities. These outcomes score within the range of 0 and 100, determents the level of functional disability, with higher numbers representing greater levels of disability. [1][3] Intended Population[edit | edit source] The Quebec back pain disability scale has been developed for several populations of patients with various disability levels who suffer diseases such as acute LBP, chronic disabling pain, sacroiliac joint dysfunction, lumbar spinal stenosis, disc surgery, and posterior surgical decompression and settings. (level of evidence: 2 ) [2] The QBPDS is a useful instrument when someone wants to get an overall impression on the improvement in Pelvic girdle pain. (level of evidence: 2B ) [6] Method of Use[edit | edit source] Patients are asked to answer the QBPDS according to the difficulty they have to perform the activities on the current day. The QBPDS examines how lower back pain affects your daily life. It is very important that the patient gives a score for every activity and is not allowed to skip an activity. (level of evidence: 2A) [2] The scoring is done by counting every digit, circled by the patient. The end score will be between 0 (no limitation) and 100 (totally limited). [4] [2] It is a very easy questionnaire and takes only five minutes. The QBPDS can be completed by patients by using paper and pen, mail, or telephone. [4] Evidence[edit | edit source] The evidence has been extensively examined. (Grade of recommendation: B) [4] Reliability[edit | edit source] The ICC is 0,55 (95% CI = 0,20-0,78) in acute occupational low back pain over a period of four weeks. [1] There is a high internal consistency for the 6-point Likert scale in other languages (Cronbach's a > 0,90). Davidson and Keating examined the test-retest reliability at patients with low back pain who reported no change during six weeks. They found an ICC of 0,85 ([95% CI] 0,73-0,91). This margin of detection is lower in chronic low back pain patients compared with acute low back pain patients. For patients older than 62 years, who suffer acute low back pain, an ICC of 0,94 and a minimal detectable change of 11,04 over a period of 11 days is established. [2] The English, French and Dutch versions have good test-retest reliability. (Grade of recommendation: B) [7] Validity[edit | edit source] Construct validity: Construct validity investigates whether the correct variables were measured in relation to the predefined variables. The Quebec back pain disability scale is able to distinguish the difference between patients’ disability levels and self-rated health. (Grade of recommendation: B) [2] The construct validity of the English, French and Dutch versions is good. (Grade of recommendation: B) [7] ⁃ Internal construct validity: Kopec, the author of the Quebec back pain disability scale, found an inter-item correlation (r) between 0,24 and 0,87 (a relatively high correlation) and an item-total correlation (r) ranged from 0,59 to 0,86 (a relatively very high correlation). The research, after Kopec’s results were published, reported an inter-item correlation lower than 0,80. (Grade of recommendation: B) [2] ⁃ External construct/convergent validity: There is a moderate to strong correlation between the Quebec back pain disability scale (QBPDS) and other disability questionnaires (Grade of recommendation: B):              - QBPDS and Roland-Morris disability questionnaire: r= 0,77-0,81              - QBPDS and Oswestry disability index: r= 0,80- 0,83              - QBPDS and physical function subscale of SF-36: r=0,67- 0,77 [4] The correlation between the QBPDS and pain (r=0,54- 0,74), psychosocial variables, and direct measures of physical function is weak to moderate. (Grade of recommendation: A) [2][4] Content and face validity: The questionnaire contains various domains of activities that patients and care providers deem important. Because of this and the good measurement properties, the content and face validity is good. (Grade of recommendation: B) [2] Responsiveness[edit | edit source] The responsiveness of the QBPDS is similar to the responsiveness of the Roland-Morris disability questionnaire, modified Oswestry disability questionnaire, Waddell disability index, and the physical function subscale of SF-36. (Grade of recommendation: C) [8] The QBPDS is highly sensitive to change for the score of the individual domains as for the total score (SRM= 0,80 and effect size= 0,62). [9] In addition, the scale is able to recognize small changes in the level of disability over time. (Grade of recommendation: B) [2] Davidson and Keating found a minimal detectable change of 19 (95% CI 14-24) in patients with low back pain who reported no change during six weeks. For patients with chronic low back pain is minimal detectable change 15.8. (Grade of recommendation: B) [2] The area under the curve (AUC) can be used as a quantitative method to differentiate patients who improved or deteriorated from the patients who stayed stable. [1] The AUC for the detection of change in patients with chronic low back pain is 0,856. This means that in 85,60 % of the cases the test correctly recognizes a change in chronic low back pain. (Grade of recommendation: B) [2] Miscellaneous[edit | edit source] The patients and the clinicians both accept the use of the QBPDS. Researchers (Kopec et al.) declare a low item default (range 0,7-1,8%) [5]. Questionnaires sent by mail had a higher rate of incomplete questionnaires (10.8%). Some patients remarked that a couple of items were not precise enough and the choice between scores 0 and 1 and between 4 and 5 wasn’t always convenient. The researchers didn’t find ceiling or floor effects in the answers. (Grade of recommendation: B) [2] Resources[edit | edit source] - The Quebec back pain disability scale website Back Pain Functional Scale - Physiopedia Introduction Back pain is a vast topic to discuss as it shows its impacts on a patient's physical, emotional, and social quality of life [1]. Furthermore, treating back pain involves considering the biopsychosocial model into aspect [1]. Besides treating back pain, there is a need for using appropriate and suitable outcome measures in clinical practice. However, none of the single outcome measures can include and assess all perspectives of pain considering the patient's quality of life into aspects. In addition, there are different outcome measures used based on the needs of patients, their severity of symptoms, and their clinical presentations[2]. Therefore, it is necessary for Health Care Professionals to use valid and reliable outcome measures to evaluate and treat back pain effectively. Consecutively, an outcome measure that has psychometric properties in terms of good validity, reliability, sensitivity, and utility should be considered in clinical practices[2]. Hence, it is necessary to know the psychometric property of an outcome measure prior to its implication. Moreover, there are lists of outcome measures used to quantify back pain scores. These are the Numerical rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), Back pain functional score, Oswestry disability index (ODI), Pain self-efficacy Questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to assess and treat back pain efficiently. However, it is not possible to use all these diagnostic tools to examine back pain functional scores. Besides, to assess the patient's quality of pain and physical function, the 'Back pain functional scale' is widely used in practice[3]. Back Pain Functional Scale[edit | edit source] The Back Pain Functional Scale (BPFS) is a subjective scale used to measure the patient's physical function after low back pain. This scale was developed by Stratford et al. (2000). It is simple and easy to understand and administer by the patients. This scale is based upon the International Classification of Function (ICF) model proposed by the World Health Organisation. It is used to evaluate the patient's level of physical independence during the initial two weeks of low back pain. However, it is not used for backpain after two weeks. This scale consists of a total score of 60. Moreover, the patient's score can be measured from the responses obtained on the Likert scale (0 to 5), and accordingly, a total score is summed up out of 60. Furthermore, the maximum score obtained indicates the maximum physical abilities of the patients. In addition, this scale also has an 'Adjusted score' ranging from 0 (0%)-unable to perform any activity to 60 (100%)-no difficulty in any activity[4]. Method of Use[edit | edit source] The BPFS consists of 12 items: Usual work, housework, or school activities Usual hobbies, recreational, or sporting activities Performance of heavy activities around your home Bending or stooping Putting on your shoes or socks Lifting a box of groceries from the floor Sleeping Standing for 1 hour Walking 1 mile Going up or down 2 flights of stairs (about 20 steps) Sitting for 1 hour Driving for 1 hour Responses Points Unable to perform activity 0 Extreme difficulty 1 Quite a bit of difficulty 2 Moderate difficulty 3 A little bit of difficulty 4 No difficulty 5 Total Score = Sum of points from all 12 measures Adjusted Total Score = Total Score / 60 Interpretation: Minimum Score: 0 Maximum Score: 60 Maximum Adjusted Score: 1 (100%) The higher the score the greater the patient's functional ability Total Score (Adjusted) Interpretation 0 (0%) unable to perform any activity 60 (100%) no difficulty in any activity Psychometric properties of Back Pain Functional Scale (BPFS)[edit | edit source] According to Stratford et al. (2000), this scale has a minimal detectable change of 22.2% with a standard error of measure of 6.5% at a 95% confidence interval. In addition, this scale has excellent test-retest reliability with an intra-class correlation coefficient of 0.88 at a confidence interval of 77%. Thus, this representation indicates that this scale can be used in the clinical setting to measure the functional outcome of patients after low back pain[4]. However, there are other functional scales used to measure physical function in patients with low back pain besides back pain functional scale. These are 'Roland-Morris disability scale', 'Oswestry disability scale', and 'Short form 36 surveys'. Therefore, it is necessary to consider the relative efficacy and effectiveness of 'Back Pain Functional Scale' as compared to other scales. Evidence[edit | edit source] There is one study aim to evaluate the correlation of back pain functional scale with other functional scales. This study has examined correlation of 'Back pain functional scale with 'Roland and Morris', 'Oswestry disability scale', and 'Short form 36 surveys'. Study Design: Correlational quantitative study Participants: 120 low back patients Recruitment: Patients were recruited from in-patient and out-patient physiotherapy rehabilitation center Study setting: This study was performed in Turkey Methods: In this study, questionnaire from each outcome measure was used and correlational analysis was performed using Spearman and Pearson statistics in order to compare the scores obtained from different outcome measures. Results: The results of this study indicate that the ' Back pain functional scale' has a good correlation with other outcomes measures used in clinical setting for assessing low back pain Conclusion: 'Back pain functional scale' can be used in the clinics for evaluating, examining, and assessing low back pain. In addition, this outcome measure is simple and easy to demonstrate and implement[3] The strength of this aforementioned study is that this article has considered the specific outcome measures ('Back pain functional scale', 'Roland-Morris scale, 'Oswestry disability scale', and 'Short form 36 surveys') used to assess physical function and found its correlation to get clear glimpses for evidence-based practice in clinical settings. However, this study has not considered the relative sensitivity of the 'Back pain functional scale' over time and thus, it is difficult to predict the persistent effects of this scale over a long period of time. Advantages and Disadvantages of Back Pain Functional scale[edit | edit source] Advantages: Easy to demonstrate and administer Good psychometric properties Used for assessing physical functions during stages weeks of back pain The patient can easily understand and use this scale Disadvantages: Cannot be used in patients having back pain after two weeks Recommendations:[edit | edit source] Further research is required to know the sensitivity of this scale over time. In addition, the aforementioned study was performed considering only 120 back pain patients[3]. However, there are approximately one-quarter of patients affected by back pain annually[2], Thus, the results obtained from this study cannot be generalizable to overall population. Hence, further research on larger population is required to prove the generalisability of the results obtained from this study[3]. Links[edit | edit source] Back Pain Functional Scale (PDF) Health Assessment Questionnaire - Disability Index (HAD-QI) - Physiopedia Introduction The Health Assessment Questionnaire - Disability Index (HAQ-DI) measures health related quality of life factors in various parts of an illness or injury process. It was initially adopted for the use in the assessment of arthritis, but can be used to assess any type of condition. It was designed to measured patient centered and patient assessed outcomes, and can be useful in conditions or life stages such as normal ageing, therapy of rheumatoid arthritis, developing risk factor models of osteoarthritis, and examination of mortality risk in rheumatoid arthritis. [1] It is a self-assessment tool used to measure functional ability in eight different areas: rising, dressing and grooming, hygiene, eating, walking, reach, grip, and activities of independent living. [2] The HAQ-DI addresses general patient centered outcomes. [1] It has been administered by the Stanford Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) many times to assess clinical status, deem the effectiveness in clinical and observational trials, and outline health qualifiers. It has been adopted by the American College of Rheumatology for measuring physical function in rheumatoid arthritis studies. [1] Development of the HAQ[edit | edit source] The HAQ-DI was developed at Stanford University. It was developed in 1978 by James F. Fries, MD, and Colleagues. The primary HAQ scale was developed at the Stanford Arthritis Center, and acknowledges the American Rheumatism Association functional class measure. [1] The components of the 2-page HAQ-DI have remained the same since near the time of developed, while the full HAQ-DI has been periodically updated with more relevant questions overtime. [1] What is the HAQ-DI & Why use it?[edit | edit source] The HAQ-DI is a quantitative tool used to assess health related quality of life assessments related to many types of injuries or illnesses. Since it was adopted through rheumatology, it can be known to only classify diseases, but as mentioned it is used across various conditions. Instead of being classified as 'disease specific', it should be classified as 'generic', since it it assesses the dimensions of death, disability, drug side effects, discomfort, and economic costs. [1] Measuring or assessing Health related quality of life is important at any stage of any condition or or injury. A valid and reliable tool, which can measure and assess over long periods greater than 6 weeks is needed for such a measurement, and thus the HAQ-DI plays an important role. [1] As mentioned, the HAQ-DI can be used in the assessment of functional ability in a multitude number of activities or conditions. It was used in a study exploring long distance running or vigorous activity and the incidence of knee osteoarthritis. [3] What it Measures[edit | edit source] The full version of the HAQ collects information of five patient-centered categories, to: [1] Avoid Disability Be free of Pain and Discomfort Avoid adverse Treatment Effects Keep dollar costs of treatments low Prevent the likelihood of Death The questionnaire also includes sections on drug side effects, medical costs, and other sections on demographics, lifestyle, and health behaviors. [1] The most commonly used version is the HAQ, which is the 'short' or 2-page version. This version includes the HAQ Disability Index (HAQ-DI), the HAQ Visual Analog Scale (VAS) for pain, and the VAS patient global health scale. [1] The disability assessment component of the HAQ, making it the HAQ-DI, measures the patient's capacity for functional tasks. [1] This collects information on fine motor skills of the upper limb, locomotion of the lower limb, and activities that jointly involve movement of the upper and lower limbs. [1] There are 20 questions which span eight categories, and account for different functional activities. [1] These eight categories include rising, dressing and grooming, hygiene, eating, walking, reach, grip, and activities of independent living. [1][2] These items are asked in terms of a span over the previous week. The patient responds on a scale of 0 (no disability) to 3 (completely disabled). There are at least two questions from each category. [1] HAQ VAS Pain Scale[edit | edit source] This scale was developed to assess the presence and severity of arthritis related pain. The intention is to gather information from the patient on their experience of the pain over the previous week, although this pain may vary between days. There are two VAS scales which are scored from 0 (no pain) to 3 (intense pain) or 0 (no pain) to 100 (intense pain). This is generally used in experimental, observational, and clinical settings.[1] Other Dimensions of the full HAQ[edit | edit source] The full HAQ also collects information on Drug Toxicity. Such information includes the name or type of drug, dosage and frequency taken, period of time drug was in use, specific side effects experienced, degree of severity of these side effects, the importance of the drug to the patient, and drug course as a result of any side effects. [1] There is also a section called summary Toxicity Index which categorises the severity of toxicity from various medications. Information relating to costs is also included in the full HAQ. Death, and mortality related information are also included in the HAQ. [1] There is also a VAS scale used in both the 2-page HAQ tool and the full HAQ, It is used to measure quality of life. It is scored from 0 (very well) to 100 (very poor). [1] Scoring[edit | edit source] The HAQ-DI is sensitive to change. It helps estimate future disability and costs. The scoring of the scale has been adapted from the American Rheumatism Association/American College of Rheumatology functional classes. [1] Each item or question is rated on a scale of 0 to 3, with 0 (normal/no difficulty), 1 (some difficulty), 2 (much difficulty), and 3 (unable to do). The highest component score within each category represents the score for that category, but not with the use of aids or other devices to complete the tasks. With the use of equipment or aids, a lower score is raised to 2, to reflect the underlying disabilities. [1] The 8 category scores are averaged, which represent an overall score from 0 (no disability) to 3 (completely disabled). If the questionnaire is slightly changed to reflect a certain disease, this does not affect the respective scoring. [1] This measurement of disability helps indicate mortality rates, rates of aging, and the usage of healthcare resources. [1] This scoring helps measure the intensity of arthritis related pain. [1] Interpretation of Scoring[edit | edit source] Scores 0-1 indicates mild to moderate disability, 1-2 indicates moderate to severe disability, and 2-3 indicates severe to very severe disability. [1] Statistical Significance[edit | edit source] The HAQ-DI has been shown to have face and content validity compared to other measurement tools for differing diseases. Construct validity, predictive validity, and sensitivity to change have been proven in many studies and clinical trials. There is also proven convergent validity based on correlations with various clinical and laboratory assessments. The validity of the HAQ pain scale and global health status scale are also strong. [1] The HAQ-DI is quite responsive to change, and is very sensitive to change when compared to other health assessment outcome measures. [1] Limitations[edit | edit source] There are a few limitations noted in regards to the HAQ-DI. It does not account for non-visible disabilities such as sensory organ dysfunctions, and psychiatric dysfunctions. It also does not collect information about patient or personal satisfaction and social activity. [1] Resources[edit | edit source] Here is a link to a document explaining the instructions to the HAQ-DI. Here is a link to the 2-page HAQ-DI from the British Columbia Ministry of Health. Here is a 2-page 20-item Disability Scale from the Stanford Patient Education Research Center

References[edit | edit source]

  1. ↑ Roland MO, Morris RW. A study of the natural history of back pain.  Part 1: Development of a reliable and sensitive measure of disability in low back pain. Spine 1983; 8: 141-144
  2. ↑ Jump up to: 2.0 2.1 2.2 2.3 Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 2000;25(24):3115-24
  3. ↑ Davies CC, Nitz AJ.Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: a systematic review. Physical Therapy Reviews, Volume 14, Number 6, December 2009 , pp. 399-408(10)
  4. ↑ Stratford PW, Binkley J, Solomon P, Finch E, Gill C, Moreland J. Defining the minimum level of detectable change for the Roland-Morris questionnaire. Phys Ther. 1996;76(4):359-65; discussion 366-8. doi: 10.1093/ptj/76.4.359. PMID: 8606899.
  5. ↑ Joy Murphy. Roland-Morris Disability Questionnaire: Jackson, Murphy, Stratman, and Jensen. Available from: http://www.youtube.com/watch?v=UKVV9dOyIPA [last accessed 26/11/2022]
  6. ↑ Jump up to: 6.0 6.1 6.2 Macedo LG, Maher CG, Latimer J. Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire. Eur Spine J. 2011;20(3):458-63
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