Outcome Assessment

This section was compiled by Frank M. Painter, D.C.
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Jump to: Outcome Articles

Functional Outcomes

Psychosocial Outcomes
Patient Satisfaction Quality of Life Outcomes in Children

Patient Satisfaction Cost-Effectiveness Safety of Chiropractic

Exercise + Chiropractic Chiropractic Rehab Integrated Care

Headache Adverse Events Disc Herniation

Chronic Neck Pain Low Back Pain Whiplash Section

Conditions That Respond Alternative Medicine Approaches to Disease

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 all that information.

The best way to copy a Word or Adobe Acrobat (PDF) file from this page is to follow this procedure:

Right-click” the URL (or link), and then select “Save Target As”,
then choose the “directory” (in your computer) where you want to save it.
When the item is saved, then select “open file”.

Adobe Acrobat files open and print much more reliably when they already reside within your own computer, especially the larger documents.


Outcome Assessment Questionnaires need to be sensitive to 3 criteria:

  1. Validity:   The degree to which an instrument measures what it is supposed to measure.

  2. Reliability:   The degree to which an instrument can produce consistent results, and consistent results on different occasions, even when there is no evidence of change.

  3. Responsiveness:   An instrument's ability to detect change over time.

The following questionnaires have been tested for accurately measuring all 3 criteria.


Articles about Outcome Questionnaires

The Outcome Assessment Guidelines
A Chiro.Org article collection

These National Guidelines come from a variety of sources.

Getting the Most Out of PROMS
(Patient-reported Outcome Measures)

The King’s Fund + The Office of Health Economics
London, UK (2010)

This 92-page document covers pretty much everything you might want to lnow about Outcomes.

View a Powerpoint Presentation About Outcome Assessment
Thanks to Dr. Steve Yeomans and the ACRB for the use of this file!
Download the FREE Powerpoint Viewer

Health-related Quality of Life Among United States Service
Members with Low Back Pain Receiving Usual Care plus
Chiropractic Care plus Usual Care vs Usual Care Alone:
Secondary Outcomes of a Pragmatic Clinical Trial

Pain Medicine 2022 (Jan 21); pnac009 [EPUB] ~ FULL TEXT

Pre-planned secondary outcomes from this rigorous, pragmatic RCT demonstrate that chiropractic care can positively impact HRQOL beyond pain and pain-related disability. This along with prior research suggests positive effects of chiropractic care on patient-reported outcomes up to 3 months. Further, PROMIS® measures of pain and pain-related disability (5 items) performed similarly to the 24-item RMDQ in the evaluation of outcomes for patients under chiropractic care. The use of PROMIS® measures encompassing physical, mental, and social health provided a richer, more holistic picture of response to chiropractic care, with less time commitment for trial participants demonstrating benefit for outcomes assessment in research and clinical practice.

Effects of Chiropractic Care on Strength, Balance, and Endurance
in Active-Duty U.S. Military Personnel with Low Back Pain:
A Randomized Controlled Trials

J Altern Complement Med 2020 (Jul); 26 (7): 592–601–693

Participants had mean age of 30 years (18-40), 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups (p = 0.003). Statistically significant differences in mean change between groups were also observed in trunk muscle endurance (13.9 sec, p = 0.002) and balance with eyes closed (0.47 sec, p = 0.01), but not in balance with eyes open (1.19 sec, p = 0.43). Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior. Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.

The Nordic Maintenance Care Program: Maintenance Care Reduces
the Number of Days With Pain in Acute Episodes and Increases
the Length of Pain Free Periods for Dysfunctional
Patients With Recurrent and Persistent Low Back Pain -
A Secondary Analysis of a Pragmatic
Randomized Controlled Tial
Chiropractic & Manual Therapies 2020 (Apr 21); 28: 19 ~ FULL TEXT

Chiropractic Maintenance Care reduces the number of days of bothersome (activity-limiting) pain within each new LBP episode among patients classified as dysfunctional (by the MPI-S instrument). MC stabilizes the clinical course and increases the number of pain-free weeks between episodes. Understanding how subgroups of patients are likely to be affected by MC may help align patients’ and clinicians’ expectations with realistic outcomes and can be used as a framework in the selection and execution of appropriate care plans. MC is not a cure that prevents new episodes but rather a management strategy that reduces bothersome (activity-limiting) pain over time for a carefully selected group of patients with recurrent and persistent LBP.

Outcome Measures for Assessing the Effectiveness of
Non-pharmacological Interventions in Frequent
Episodic or Chronic Migraine:
A Delphi Study

BMJ Open. 2020 (Feb 12); 10 (2): e029855 ~ FULL TEXT

The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.

The Nordic Maintenance Care Program: Does Psychological Profile
Modify the Treatment Effect of a Preventive Manual Therapy
Intervention? A Secondary Analysis of a Pragmatic
Randomized Controlled Trial
PLoS One. 2019 (Oct 10); 14 (10): e0223349 ~ FULL TEXT

Psychological characteristics appears to modify the effect of Maintenance Care (MC) and should be taken into consideration in the long-term management of patients with recurrent and persistent LBP. Patients who show a favorable response to an initial course of chiropractic care should be considered for MC if they report high pain severity, marked interference with everyday life due to pain, high affective distress, low perception of life control and low activity levels at baseline. Patients who, on the other hand, report low pain severity, low interference with everyday life due to pain, low life distress, high activity levels and a high perception of life control should probably not be recommended MC and instead only receive care when they experience a relapse of pain.

Researching the Appropriateness of Care in the Complementary
and Integrative Health Professions Part 3:
Designing Instruments With Patient Input

J Manipulative Physiol Ther. 2019 (Jun); 42 (5): 307–318 ~ FULL TEXT

It is important to collect valid data about patients’ experiences and beliefs for research and clinical care. In many instances, as with our study, the best approach may be to use existing measures for some constructs, to modify existing measures for other constructs, and to create entirely new measures for constructs where the existing measures are insufficient. In this article, we have described how we used multiple qualitative methods and a review of the literature to identify constructs and then design questionnaires that were successfully administered as part of a national survey of chiropractic patients with chronic low back and neck pain. We have presented preliminary reliability and validity data for one of our novel measures, which addresses coping behaviors. We have also outlined suggestions for CIH researchers and providers who want to collect this sort of information from patients.

Development and Validation of the EXPECT Questionnaire:
Assessing Patient Expectations of Outcomes of
Complementary and Alternative Medicine Treatments
for Chronic Pain

J Altern Complement Med. 2016 (Nov);   22 (11):   936–946 ~ FULL TEXT

The EXPECT questionnaire can be used in research to assess individuals’ expectations of treatments for chronic pain. Several directions for future research are indicated. Further research is needed to assess the psychometric characteristics of the EXPECT questionnaire and short form in samples with different sociodemographic and clinical characteristics. Examination of the association of EXPECT scores with outcomes after CAM treatments may help increase knowledge about the role of individuals’ expectations in their outcomes after CAM treatments. Finally, although the questionnaire can be used with individuals beginning CAM treatments for CLBP, the questionnaire might be adapted for use with individuals with other pain problems and for use with non-CAM treatments.

Outcomes and Outcomes Measurements Used in Intervention Studies
of Pelvic Girdle Pain and Lumbopelvic Pain:
A Systematic Review

Chiropractic & Manual Therapies 2019 (Nov 5);   27:   62 ~ FULL TEXT

Studies and systematic reviews examining the effectiveness of interventions for PGP and LPP assess a range of outcomes, predominantly pain intensity and disability/function, and use a large variety of outcome measurement instruments. Few studies examine adverse events and economic outcomes. Not only do different studies often measure different outcomes, authors also rarely define outcomes and terminology for outcomes varies, making comparison of study findings very difficult.

Chiropractors' Views on the Use of Patient-reported Outcome
Measures in Clinical Practice: A Qualitative Study

Chiropractic & Manual Therapies 2018 (Dec 18);   26:   50 ~ FULL TEXT

Chiropractors are increasingly using PROMs in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using PROMs. Exploring chiropractors’ experience of using PROMs, this study identified how clinician knowledge and engagement and organisational barriers and facilitators affect implementing PROMs in chiropractic care, such as choosing the appropriate PROMs and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding PROMs, with training including the process and benefits of using PROMs in clinical practice. The results from the study also demonstrated the necessity of ensuring PROMs are meaningful to patients and chiropractors. It is clear there are differing views and engagement with PROMs within clinical practice; in addition, future research must consider patients’ views on completing PROMs and how it affects the process of clinical practice and outcomes.

Brief Screening Questions for Depression in Chiropractic Patients
with Low Back Pain: Identification of Potentially Useful
Questions and Test of Their Predictive Capacity

Chiropractic & Manual Therapies 2014 (Jan 17); 22: 4 ~ FULL TEXT

Pain and depression often co-exist [1–3] , and although the causal relation between the two is not clear, [4, 5] evidence suggests that pain negatively affects outcome in depression as well as vice versa [6]. Low back pain (LBP) is a highly frequent pain condition with a substantial impact on global health [7] for which the risk of a poor prognosis is increased in the presence of depression [8, 9] . It is a condition for which there is no generally effective treatment, but non-pharmacological treatment addressing psychological symptoms in addition to the physical symptoms has been demonstrated to improve outcome in LBP patients with high scores on psychological questions [10].

Measures of Adult Pain
Arthritis Care Res (Hoboken) 2011 (Nov); 63 Suppl 11: S240-252 ~ FULL TEXT

There are multiple measures available to assess pain in adult rheumatology populations. Each measure has its own strengths and weaknesses. Both the Visual Analog Scale for Pain and the Numeric Rating Scale (NRS) for Pain are unidimensional single-item scales that provide an estimate of patients’ pain intensity. They are easy to administer, complete, and score. Of the 2, the pain NRS may be preferred at point of patient care due to simpler scoring.

Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction
Associated with Upper Cervical Chiropractic Care:
A Prospective, Multicenter, Cohort Study

BMC Musculoskelet Disord. 2011 (Oct 5);   12:   219 ~ FULL TEXT

A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had symptomatic reactions (SRs) meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.

Psychosocial Risk Factors For Chronic Low Back Pain
in Primary Care — A Systematic Review

Fam Pract. 2011 (Feb);   28 (1):   12–21 ~ FULL TEXT

Twenty-three papers fulfilled the inclusion criteria, covering 18 different cohorts. Sixteen psychosocial factors were analysed in three domains: social and socio-occupational, psychological and cognitive and behavioural. Depression, psychological distress, passive coping strategies and fear-avoidance beliefs were sometimes found to be independently linked with poor outcome, whereas most social and socio-occupational factors were not. The predictive ability of a patient's self-perceived general health at baseline was difficult to interpret because of biomedical confounding factors. The initial patient's or care provider's perceived risk of persistence of LBP was the factor that was most consistently linked with actual outcome.

A Critical Piece of Quality Documentation:
Outcomes Assessment

American Chiropractor 2011 (May):   33 (5):   28–34 ~ FULL TEXT

Outcomes assessment tool availability is not a new concept. Back in the 1970’s, long, impractical outcomes tools surfaced that were too cumbersome for routine use in a primary care setting, but shortly thereafter, in 1980, Fairbank introduced the Oswestry (Low Back) Disability Index (ODI). An interesting point is that the original purpose of the ODI was to identify patients that may require “…positive intervention” in the form of psychological care when scores exceeded 60% (defined as “crippled”).

Assessment of Patients With Neck Pain: A Review of
Definitions, Selection Criteria, and Measurement Tools

J Chiropractic Medicine 2010 (Jun); 9 (2): 49–59 ~ FULL TEXT

The introduction of evidence-based practice in the last years of the 20th century stimulated the development and research of an enormous number of instruments to assess many types of patient variables. [1] Now, more rehabilitation professionals are familiarizing themselves with the use of outcome measures in clinical practice and for research purposes. [2, 3] Outcomes assessment is primarily designed to establish baselines, to evaluate the effect of an intervention, to assist in goal setting, and to motivate patients to evaluate their treatment. [4, 5] When used in a clinical setting, it can enhance clinical decision making and improve quality of care. [6] Many patients with neck pain visit health care clinics seeking treatment of their problem, and health professionals aim to use the best available evidence for making decisions about therapy. The best evidence comes from randomized clinical trials, systematic reviews, and evidence-based clinical practice guidelines. [7]

Expectations for Recovery Important in the
Prognosis of Whiplash Injuries

PLoS Med. 2008 (May 13); 5 (5): e105 ~ FULL TEXT

In conclusion, we suggest early assessment of expectations for recovery to be made, in order to identify people at risk for poor prognosis after WAD. Furthermore, controlled studies on interventions aimed at modifying expectations are warranted. Such studies could be conducted on the population level, similar to the successful media campaign on back pain beliefs, which decreased disability claims, both in terms of incidence and time on benefits. [31, 32] Alternatively interventions targeting persons in the acute phase of an injury should be evaluated. Finally, it is not inconceivable that our findings can be extended to persons with pain conditions other than WAD.

Implementation of Outcome Measures in a Complementary and
Alternative Medicine Clinic: Evidence of Decreased
Pain and Improved Quality of Life

J Altern Complement Med 2004 (Jul); 10 (3): 506–513

This study established that a practical data collection system could be implemented in a CAM clinic utilizing several treatment modalities. In addition, outcome measures demonstrated both a significant reduction in pain and improvement in quality of life for subjects who utilized acupuncture, chiropractic, or naturopathy treatments.

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.

Assessing the Clinical Significance of Change Scores
Recorded on Subjective Outcome Measures

J Manipulative Physiol Ther 2004 (Jan); 27 (1): 26–35 ~ FULL TEXT

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.

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 ~ FULL TEXT

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.

A Comparison of Five Low Back Disability Questionnaires:
Reliability and Responsiveness

Physical Therapy 2002 (Jan); 82 (1): 8–24 ~ FULL TEXT

Our data indicate that the Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale have sufficient reliability and scale width to be applied in an ambulatory clinical population with low back problems. The Waddell Disability Index has insufficient scale width for clinical utility. The Roland-Morris Disability Questionnaire and the SF-36 Role Limitations–Physical and Bodily Pain scales did not have sufficient reliability to be recommended as clinical outcome measures for individual patients. This study showed that the responsiveness of the questionnaires was similar, and we conclude that one questionnaire cannot be preferred over another based on the magnitude of the absolute values of responsiveness indexes.

The Relationship of Disability (Oswestry) and Pain Drawings
to Functional Testing

European Spine Journal 2000 (Jun); 9 (3): 208–212 ~ FULL TEXT

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.

Behavioral Responses to Examination: A Reappraisal
of the Interpretation of "Nonorganic Signs"

Spine (Phila Pa 1976) 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
Dynamic Chiropractic (October 20, 1997)

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
Dynamic Chiropractic (April 6, 1998)

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.
Return to:   The Outcomes Documentation Section


Functional Outcome Questionnaires

   The RAND 36-Item Short Form Health Survey   (SF-36)   

Rand SF-36 ~   in Word    or    as a PDF
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.

How to score the SF-36 ~   in Word    or    as a PDF    or   

as a Web Page Document (HTML)
These pages takes you on a step–by–step method for scoring the Rand–36.

Scoring Page for SF-36 ~   in Word    or    as a PDF    or

as a Web Page Document (HTML)
This page is for tallying the score from the Rand–36 and can be stored in the patient file.

Measuring Functional Health Status in the Chiropractic
Office Using Self-Report Questionnaires

Topics in Clinical Chiropractic 1994: 1 (1): 51–59 ~ FULL TEXT

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 questionnaire is located on page 81-83.

NOTE:   This WORD doc is formatted to be printed on both sides of a page, to create a 2-page document. It is formatted with a 1-inch border on the left-side of the first page, for easy inclusion in the patient file. The second WORD page is printed on the back of page one, and the 4th page is printed on the back of page 2, so that you have 2 double-sided pages. Then, I printed them in bulk, at a copy store, on machines designed to print double-sided documents quickly and accurately.

Responsiveness of the Cervical Northern American Spine Society
Questionnaire (NASS) and the Short Form 36 (SF-36)
in Chronic Whiplash

Clin Rehabil. 2012 (Feb); 26 (2): 142–151

The NASS was consistently less responsive in function than the SF-36 and cannot be recommended as a specific instrument to measure pain and function more responsively than the SF-36 in chronic whiplash disorder.   The SF-36 seems to be a powerful, responsive instrument in chronic pain.

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   (NDI)   

Neck Disability Index (NDI) ~   in Word   or    as a PDF (PDF)
This modified Oswestry questionnaire is a 2 sided form....with a pain diagram on the second side.   The borders are alligned so you can make it into a two-sided sheet, which can be side-punched (on the 11" side) and put into the patient file.

Scoring Methodology and comments by author Howard Vernon, D.C.
The scoring method also available in  Adobe Acrobat (PDF).

Classifying Whiplash Recovery Status Using the Neck
Disability Index: Optimized Cutoff Points Derived
From Receiver Operating Characteristic

J Chiropractic Medicine 2016 (Jun); 15 (2): 95–101 ~ FULL TEXT

Although the optimal or perfect NDI score is 0, population studies have indicated that scores of generally healthy asymptomatic persons range from 4 to 5 in children to 7 in adults. Our goal was to investigate the optimal cutoff point for NDI score for a group of American adults who had suffered whiplash injury using their self-assessment of recovery as the state variable or criterion standard. The results of our investigation indicate that the optimal NDI score cutoff point for differentiating the recovery state after whiplash is 15. Misclassification errors are likely when using lower values.

The Neck Disability Index: State-of-the-Art, 1991-2008
J Manipulative Physiol Ther 2008 (Sep); 31 (7): 491–502 ~ FULL TEXT

The NDI has been translated into 22 languages, with 6 published reports and 1 large Web-based resource with 18 readily available versions. It has been used in 52 surgical clinical trials and 3 trials of injection therapies as well as RCTs of numerous conservative therapies, chiefly manipulation and exercise. In this regard, it has served to expand the range of outcome measurements of neck pain patients beyond the limited use of pain scales and has enriched the yield of these clinical trials.

Comparison of the Neck Disability Index and the
Neck Bournemouth Questionnaire in a Sample of
Patients with Chronic Uncomplicated Neck Pain

J Manipulative Physiol Ther 2007 (May); 30 (4): 259–262 ~ FULL TEXT

The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain. Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain. Both had acceptable internal consistency and are appropriate for use as single-outcome scales.

The Reliability of the Vernon and Mior Neck Disability Index,
and its Validity Compared With the Short Form-36
Health Survey Questionnaire

European Spine Journal 2007 (Dec); 16 (12): 2111–2117 ~ FULL TEXT

The correlations between each item of the NDI scores and the total NDI score ranged from 0.447 to 0.659, (all with P < 0.001). The test-retest reliability of the NDI was high (intra-class correlation 0.93, 95% confidence limits 0.86-0.97) and comparable with the best values found for SF36. The correlations between NDI and SF36 domains ranged from -0.45 to -0.74 (all with P < 0.001). We have shown that the NDI has good reliability and validity and that it compares well with the SF36 in the spinal surgery out patient setting.

Psychometric Properties of the Neck Disability Index
J Manipulative Physiol Ther 1998 (Feb); 21 (2): 75–80

Results from 237 neck pain patients show that the responses given on the eight versions of the NDI are a function of the content and not of the format in which the items are presented.   The NDI has stable psychometric characteristics, evidenced by high internal consistency (alpha = .92).   In both factor analyses, one factor was extracted.   The NDI possesses stable psychometric properties and provides an objective means of assessing the disability of patients suffering from neck pain.

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 Low Back Pain Questionnaire   (OLB)   

Oswestry Low Back Pain Questionnaire ~   in Word    or    in Adobe Acrobat (PDF)
This questionnaire is the J. Fairbanks QA from the journal Physiotherapy 1980; 66: 271, and comes with a second page, containing a pain drawing. Please note that the scoring methodology is the same as with the NDI.

Scoring Methodology (HTML)
The scoring method also available in  Adobe Acrobat (PDF).

The Oswestry Disability Index
Spine (Phila Pa 1976) 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 Bournemouth Back and Neck Questionnaires   

Bournemouth Back   PDF

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 ~ FULL TEXT

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   PDF

No scoring method is available on our website

Sensitivity And Specificity Of Outcome Measures In Patients
With Neck Pain: Detecting Clinically Significant Improvement

Spine (Phila Pa 1976). 2004 (Nov 1); 29 (21): 2410–2417

The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients' Global Impression of Change (11-point Numerical Rating Scale: 0 = much better, 5 = no change, and 10 = much worse) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Questionnaire. For the total score of the Bournemouth Questionnaire, raw change scores of 13 or more points, percentage change scores of 36% or more, and individual effect sizes of 1.0 or more were all associated with clinically significant improvement. The sensitivity of the Bournemouth Questionnaire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index.

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 ~ FULL TEXT

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 Functional Rating Index   (FRI)   

The Functional Rating Index (FRI)   PDF
Patient-centered outcome instruments are now widely recognized as valuable assessment tools for researchers, doctors, patients and payors. The need to measure the function of the neck and back and to demonstrate clinical effectiveness has resulted in many reliable and valid patient report instruments being produced. Yet, existing self-report instruments measuring spinal pain and dysfunction require too much time for patients to answer (5 to 10 minutes per instrument) and health care workers to score (1 to 5 minutes per instrument) and, therefore, are underutilized in daily practice.

A new instrument, the Functional Rating Index, reduces the administrative burden. Functional Rating Index has been tested, and the initial results have been published in Spine. Medical Science Monitor has published a scientific review of 10 independent studies on the Functional Rating Index. The researchers found that the Functional Rating Index demonstrates favorable measurement properties of reliability, validity and responsiveness, and it significantly reduces administrative burden. On average, Functional Rating Index requires only about one minute for a patient to complete and about 20 seconds for a health care worker to score. Additionally, this instrument can be used with cervical, thoracic or lumbar conditions, which reduces the need for multiple instruments for spine-related conditions.

The Functional Rating Index Scoring Protocol
You will need to e-mail them at chiroevidence.com to ask for their "complimentary copy of the Functional Rating Index scoring protocols"

Functional Rating Index: A New Valid and Reliable Instrument
to Measure the Magnitude of Clinical Change
in Spinal Conditions

Spine (Phila Pa 1976). 2001 (Jan 1); 26 (1): 78–86

The Functional Rating Index correlated with the Disability Rating Index (0.76), the Short Form-12 Physical Component Score (0.76), and the Short Form-12 Mental Component Score (0.36). Responsiveness: Overall, the size effect was 1.24, which is commendable. Clinical utility: Time required by the patient and staff averaged 78 seconds per administration, which is noteworthy. Effect of Sociodemographics: Total scores were not affected by education, gender, nor age, suggesting minimal external validity bias. nbsp; The Functional Rating Index appears to be psychometrically sound with regard to reliability, validity, and responsiveness and is clearly superior to other instruments with regard to clinical utility. The Functional Rating Index is a promising useful instrument in the assessment of spinal conditions.


    The Quadruple Visual Analogue Scale   (VAS)   

The Quadruple Visual Analogue Scale   PDF
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 Manipulative Physiol Ther 2001 (Oct); 24 (8): 501–504 ~ FULL TEXT

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.

Cut-off Points for Mild, Moderate, and Severe Pain
on the Visual Analogue Scale for Pain in Patients
with Chronic Musculoskeletal Pain

Pain 2014 (Dec); 155 (12): 2545–2550 ~ FULL TEXT

The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with chronic musculoskeletal pain. A total of 456 patients were included. Pain was assessed using the VAS and verbal rating scale; functioning was assessed using the domains of the Short Form (36) Health Survey (SF-36). Eight cut-off point schemes were tested using multivariate analysis of variance (MANOVA), ordinal logistic regression, and latent class analysis. The study results showed that VAS scores ≤ 3.4 corresponded to mild interference with functioning, whereas 3.5 to 6.4 implied moderate interference, and ≥ 6.5 implied severe interference.

Cut Points for Mild, Moderate, and Severe Pain on
the VAS for Children and Adolescents: What Can Be
Learned from 10 Million ANOVAs?

Pain 2013 (Dec); 154 (12): 2626–2632 ~ FULL TEXT

Cut points that classify pain intensity into mild, moderate, and severe levels are widely used in pain research and clinical practice. At present, there are no agreed-upon cut points for the visual analog scale (VAS) in pediatric samples. We applied a method based on Serlin and colleagues' procedure (Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. PAIN(Æ) 1995;61:277-84) that was previously only used for the 0 to 10 numerical rating scale to empirically establish optimal cut points (OCs) for the VAS and used bootstrapping to estimate the variability of these thresholds. We analyzed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study and defined OCs both for parental ratings of their children's pain and adolescents' self-ratings of pain intensity. Data from 2276 children (3 to 10 years; 54% female) and 2982 adolescents (11 to 17 years; 61% female) were analyzed. OCs were determined in a by-millimeter analysis that tested all possible 4851 OC combinations, and a truncated analysis were OCs were spaced 5 mm apart, resulting in 171 OC combinations. The OC method identified 2 different OCs for parental ratings and self-report, both in the by-millimeter and truncated analyses. When we estimated the variability of the by-millimeter analysis, we found that the specific OCs were only found in 11% of the samples. The truncated analysis revealed, however, that cut points of 35:60 are identified as optimal in both samples and are a viable alternative to separate cut points. We found a set of cut points that can be used both parental ratings of their children's pain and self-reports for adolescents. Adopting these cut points greatly enhances the comparability of trials. We call for more systematic assessment of diagnostic procedures in pain research.


   Patient Global Impression of Change   

Patient Global Impression of Change   PDF
No scoring method is available on our website
The Patient Global Impression of Change (PGIC) is a self-reported 7-point Likert scale where a patient assesses his or her degree of change since starting treatment, ranging from very much better to very much worse. The PGIC has been well validated and has been commonly used by pain researchers as a standard outcome instrument.

Clinical Importance of Changes in Chronic Pain Intensity
Measured on an 11-point Numerical Pain Rating Scale

Pain 2001 (Nov); 94 (2): 149–158

To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used. The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point Patient Global Impression of Change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject. Categories of "much improved" and "very much improved" were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses. A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group.


   The McGill Pain Questionnaire   

McGill Pain Questionnaire (20 Question Version)   PDF
No scoring method is available on our website

McGill Pain Questionnaire (Short Form)   PDF
No scoring method is available on our website

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 (Aug); 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.


   The Copenhagen Neck Disability Scale   

Copenhagen Neck Disability Scale   PDF
No scoring method is available on our website

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 Roland–Morris Questionnaire   

Roland–Morris ~ in Word    or    as a PDF
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!

How to score the Roland–Morris Questionnaire
A simple, step-by-step analysis, courtesy of the Illinois Chiropractic Society.

The Roland–Morris Questionnaire
There is an abbreviated 18 question low back QA here in this article by Craig Liebenson...check it out!

A Cross-sectional Study Comparing the Oswestry and Roland-Morris
Functional Disability Scales in Two Populations of Patients
with Low Back Pain of Different Levels of Severity

Spine 1997 (Jan 1); 22 (1): 68–71

Patients diagnosed with low back pain who exhibited signs of radiculopathy on electromyography had a mean score of 49.1 +/- 17.1 on the Oswestry disability questionnaire; a mean score of 33.0 +/- 14.7 was found for patients who experienced "simple" low back sprain (with no radiculopathy). This difference was statistically significant (P < 0.0001). On the Roland-Morris questionnaire, the mean score obtained by the group of patients with radiculopathy was 59.1 +/- 21.8 compared with 45.4 +/- 19.4 for those with no radiculopathy. This difference was also statistically significant (P < 0.0001). Moreover, there exists a moderate correlation between both functional scales within each group of patients: 0.72 (P < 0.0001) in the group with radiculopathy and 0.66 (P < 0.0001) among those without radiculopathy.


    Measure Yourself Medical Outcome Profile   (MYMOP)   

Measure Yourself Medical Outcome Profile Questionnaire   PDF
This is the Initial Form. The Follup-up Form   PDF is also available.

Measure Yourself Medical Outcome Profile Scoring Methodology   PDF

Use of the Measure Your Medical Outcome Profile (MYMOP2) and
W-BQ12 (Well-Being) Outcomes Measures to Evaluate
Chiropractic Treatment: An Observational Study

Chiropractic & Manual Therapies 2011 (Mar 20); 19 (1): 7 ~ FULL TEXT

This study assesses the use of the MYMOP2 and W-BQ12 questionnaires as outcome measures to monitor changes following chiropractic therapy. Within the limitations of this study, it was shown that both questionnaires were responsive to change. The MYMOP2 also correlated well with the W-BQ12 questionnaire. It thus appears to be a useful instrument for assessing change among chiropractic patients and in the assessment of patient perceived wellbeing for chiropractic patients who present with a variety of symptoms and clinical conditions.


   Functional Rating Index   

Functional Rating Index   PDF
You may request a complimentary copy of the FRI scoring protocols from the Institute of Evidence-Based Chiropractic (owners).

Functional Rating Index: Literature Review
Med Sci Monit. 2010 (Feb); 16: RA25–36

In 1999, a new self-report outcome measure, the Functional Rating Index (FRI), was developed and tested. This measure demonstrated reasonable reliability, validity and responsiveness. Since the publication of the original testing, numerous independent research teams have examined the psychometric qualities of the FRI and published their findings. The aim of this study is to review the psychometric properties of the FRI as reported by published studies.

Functional Rating Index: A New Valid and Reliable Instrument
to Measure the Magnitude of Clinical Change
in Spinal Conditions

Spine (Phila Pa 1976). 2001 (Jan 1); 26 (1): 78–86

The Functional Rating Index appears to be psychometrically sound with regard to reliability, validity, and responsiveness and is clearly superior to other instruments with regard to clinical utility. The Functional Rating Index is a promising useful instrument in the assessment of spinal conditions.


   The Patient-Specific Functional Scale   

The Patient-Specific Functional Scale   PDF
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

The Patient-Specific Functional Scale: Psychometrics,
Clinimetrics, and Application as a Clinical Outcome Measure

J Orthop Sports Phys Ther. 2012 (Jan); 42 (1): 30–42

There has been a shift in current health practices toward patient-focused outcome measures in rehabilitation. [43] In response to this shift, the need for individualized outcome measures has become more apparent. [20, 43] Stratford et al [69] describe this in more detail as being a change from impairment-based to function-based measurement. This view is supported by Pengel et al, [58] who found that disability and function measures were more responsive than impairment measures in a population with subacute low back pain. A move away from practitioner-based measures to a more holistic approach, centering on the patient and the patient's quality of life, has been described by several authors. [20, 48]

Responsiveness of Pain and Disability Measures
or Chronic Whiplash

Spine (Phila Pa 1976) 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.


   Migraine Disability Assessment (MIDAS)   

Migraine Disability Assessment (MIDAS)   PDF
The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches have on your life. The information on this questionnaire is also helpful for your primary care provider to determine the level of pain and disability caused by your headaches and to find the best treatment for you.

Validity of the Migraine Disability Assessment (MIDAS) Score
in Comparison to a Diary-based Measure in a Population
Sample of Migraine Sufferers

Pain. 2000 (Oct); 88 (1): 41–52

The mean and median values for the MIDAS score in a population-based sample of migraine cases were similar to equivalent diary measures. The correlation between the two measures was in the low moderate range, but expected given that two very different methods of data collection were compared.


   Headache Impact Test (HIT-6)   

Headache Impact Test (HIT-6)   PDF
This questionnaire was designed to help you describe and communicate the way you feel and what you cannot do because of headaches.

Validation of the Headache Impact Test (HIT-6™)
Across Episodic and Chronic Migraine

Cephalalgia. 2011 (Feb);   31 (3):   357–367

Results from these analyses confirm that the HIT-6 is a reliable and valid tool for discriminating headache impact across episodic and chronic migraine.


Psychosocial Outcome Questionnaires

   The Pain Catastrophizing Scale   

The Pain Catastrophizing Scale

Everyone experiences painful situations at some point in their lives. Such experiences may include headaches, tooth pain, joint or muscle pain. People are often exposed to situations that may cause pain such as illness, injury, dental procedures or surgery. We are interested in the types of thoughts and feeling that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the scale, please indicate the degree to which you have these thoughts and feelings when you are experiencing pain.

Pain Catastrophizing Scale

Pain catastrophizing is characterized by the tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain, as well as by a relative inability to prevent or inhibit pain-related thoughts in anticipation of, during, or following a painful event. [1] Pain catastrophizing affects how individuals experience pain. Sullivan et al 1995 state that people who catastrophize tend to do three things, all of which are measured by this questionnaire.

Pain Catastrophizing: An Updated Review
Indian J Psychol Med. 2012 (Jul-Sep); 34(3): 204–217 ~ FULL TEXT

Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions. It is a distinct phenomenon which is characterized by feelings of helplessness, active rumination and excessive magnification of cognitions and feelings toward the painful situation. Susceptible subjects may have certain demographic or psychological predisposition. Various models of pain catastrophizing have been proposed which include attention-bias, schema-activation, communal-coping and appraisal models. Nevertheless, consensus is still lacking as to the true nature and mechanisms for pain catastrophizing. Recent advances in population genomics and noninvasive neuroimaging have helped elucidate the known determinants and neurophysiological correlates behind this potentially disabling behavior.


   Major Depression Inventory (MDI)   

Major Depression Inventory (MDI)   PDF
This document contains the questionnaire, scoring methodology and other scoring instructions.

The Internal and External Validity of the Major Depression Inventory
in Measuring Severity of Depressive States

Psychol Med. 2003 (Feb); 33 (2): 351–35–539

In total, 91 patients were included. The results showed that the MDI had an adequate internal validity in being a unidimensional scale (the total score an appropriate or sufficient statistic). The external validity of the MDI was also confirmed as the total score of the MDI correlated significantly with the HAM-D (Pearson's coefficient 0.86, P < or = 0.01, Spearman 0.80, P < or = 0.01). When used in a sample of patients with different states of depression the MDI has an adequate internal and external validity.


   The Questionnaire for Assessing Psychosocial Yellow Flags   

Questionnaire for Assessing Psychosocial Yellow Flags
This is the QA designed by Linton & Hallden 1996.

Return to the:   Documentation Section

Refer also to the:   New Zealand Acute Low Back Pain Guide   PDF


   The NeckPix(©) Tool for Assessing Kinesiophobia   

The NeckPix(©) Questionnaire   PDF
Thanks to Dr. Marco Monticone for releasing the NeckPix QA to the profession!

Responsiveness and Minimal Important Change of the NeckPix(©)
in Subjects with Chronic Neck Pain Undergoing Rehabilitation

European Spine Journal 2018 (Jun); 27 (6): 1324–1331

The NeckPix was sensitive in detecting clinical changes in subjects with chronic neck pain undergoing rehabilitation. We recommend taking the minimal important changes (MICs) provided into account when assessing subjects' improvement or planning studies in this clinical context.

The NeckPix(©): Development of an Evaluation Tool for Assessing
Kinesiophobia in Subjects with Chronic Neck Pain

European Spine Journal 2015 (Jan); 24 (1): 72-79

NeckPix(©), which was successfully developed following international recommendations, proved to have a good factorial structure and satisfactory psychometric properties. Its use is recommended for research purposes.


   Fear Avoidance Beliefs Questionnaire (FABQ)   

Fear Avoidance Beliefs Questionnaire (FABQ)
The FABQ was developed by Waddell to investigate fear-avoidance beliefs among LBP patients in the clinical setting. [3] This survey can help predict those that have a high pain avoidance behavior. Clinically, these people may need to be supervised more than those that confront their pain.
Questionnaire AND the Scoring Methodology are included.

The Predictive Effect of Fear-avoidance Beliefs on Low Back
Pain Among Newly Qualified Health Care Workers With and
Without Previous Low Back Pain: A Prospective Cohort Study

BMC Musculoskelet Disord. 2009 (Sep 24); 10: 117 ~ FULL TEXT

Health care workers have a high prevalence of low back pain (LBP). Although physical exposures in the working environment are linked to an increased risk of LBP, it has been suggested that individual coping strategies, for example fear-avoidance beliefs, could also be important in the development and maintenance of LBP. Accordingly, the main objective of this study was to examine (1) the association between physical work load and LBP, (2) the predictive effect of fear-avoidance beliefs on the development of LBP, and (3) the moderating effect of fear-avoidance beliefs on the association between physical work load and LBP among cases with and without previous LBP.

A Fear-Avoidance Beliefs Questionnaire (FABQ) and the Role
of Fear-avoidance Beliefs in Chronic Low Back Pain
and Disability

Pain. 1993 (Feb); 52 (2): 157–168

Test-retest reproducibility in 26 patients was high. Principal-components analysis of the questionnaire in 210 patients identified 2 factors: fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity with internal consistency (alpha) of 0.88 and 0.77 and accounting for 43.7% and 16.5% of the total variance, respectively. Regression analysis in 184 patients showed that fear-avoidance beliefs about work accounted for 23% of the variance of disability in activities of daily living and 26% of the variance of work loss, even after allowing for severity of pain; fear-avoidance beliefs about physical activity explained an additional 9% of the variance of disability. These results confirm the importance of fear-avoidance beliefs and demonstrate that specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain. These findings are incorporated into a biopsychosocial model of the cognitive, affective and behavioural influences in low back pain and disability. It is recommended that fear-avoidance beliefs should be considered in the medical management of low back pain and disability.


    The Tampa Scale of Kinesiophobia   (TSK)   

Tampa Scale of Kinesiophobia   PDF
The Tampa Scale of Kinesiophobia (TSK) that was developed in 1990 is a 17 item scale originally developed to measure the fear of movement related to chronic lower back pain.

The Tampa Scale of Kinesiophobia and Neck Pain, Disability
and Range of Motion: A Narrative Review of the Literature

J Can Chiropr Assoc. 2011 (Sep); 55 (3): 222–232 ~ FULL TEXT

The fear avoidance model can be applied to neck pain sufferers and there is value from a psychometric perspective in using the TSK to assess kinesiophobia. Future research should investigate if, and to what extent, other measureable factors commonly associated with neck pain, such as decreased range of motion, correlate with kinesiophobia.

Norming of the Tampa Scale for Kinesiophobia
Across Pain Diagnoses and Various Countries

Pain. 2011 (May); 152 (5): 1090–1095

The present study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), a frequently used measure of fear of movement/(re)injury. Norms were assessed for the TSK total score as well as for scores on the previously proposed TSK activity avoidance and TSK somatic focus scales. Data from Dutch, Canadian, and Swedish pain samples were used (N=3082). Norms were established using multiple regression to obtain more valid and reliable norms than can be obtained by subgroup analyses based on age or gender.


Patient Satisfaction Questionnaires

   Visit-Specific Satisfaction Instrument (VSQ-9)   

Visit-Specific Satisfaction Instrument (VSQ-9)   PDF
The VSQ-9 is a visit-specific satisfaction instrument adapted by the American Medical Group Association from the Visit Rating Questionnaire used in the Medical Outcomes Study, a two-year study of patients with chronic conditions.

Scoring Methodology

Patient Satisfaction Survey as a Tool Towards Quality Improvement
Oman Med J. 2014 (Jan); 29 (1): 3–7

Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations. However, there are very few published studies reporting of the improvements resulting from feedback information of patient satisfaction surveys, and in most cases, these studies are contradictory in their findings. This article investigates in-depth a number of research studies that critically discuss the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations.


Quality of Life Questionnaires

   Patient Reported Outcomes Measurement Information System (PROMIS)   

PROMIS Pediatric Profile v2.0   PDF
PROMIS® (Patient-Reported Outcomes Measurement Information System) is a set of person-centered measures that evaluates and monitors physical, mental, and social health in adults and children. It can be used with the general population and with individuals living with chronic conditions.

Visit the PROMIS® website for other related questionnaires
HealthMeasures @ Northwestern University

PROMIS developed self-report measures for adults for the functions, symptoms, behaviors, and feelings shown here. Measures are applicable to the general population and to those with chronic conditions.

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