How you evaluate treatment results in low back pain patients depends on who the patient is

Publikation: Bidrag til bog/antologi/rapport/konference-proceedingKonferenceabstrakt i proceedingsForskning

Resumé

Background

The choice of an evaluative instrument in back pain patients is complicated because of lack of head-to-head comparisons of clinimetric properties of the various instruments. In addition, little is known about instrument behaviour in clinical subgroups. The objective of this study was to concurrently compare responsiveness and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients.

Methods

The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0-10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP.

Results

RMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM=0.5-1.4; ROC=0.75-0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4-0.9; ROC = 0.76-0.89; RMQ: SRM = 0.3-0.9; ROC = 0.72-0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM=1.3-1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM=1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51%) and RMQ (38%) specifically and differed in the subpopulations.

Conclusions

RMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for LBP patients with concurrent leg pain irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement.

OriginalsprogEngelsk
TitelProceedings
Antal sider1
ForlagForsknings- og Innovationsstyrelsen
Publikationsdato2009
Sider1
StatusUdgivet - 2009
BegivenhedForskningens Dag - Middelfart, Danmark
Varighed: 30. apr. 200930. apr. 2009

Konference

KonferenceForskningens Dag
LandDanmark
ByMiddelfart
Periode30/04/200930/04/2009

Emneord

  • Spørgeskemaer
  • Undergrupper
  • Mindste kliniske relevante ændring
  • Rygsmerter
  • Funktion
  • Smerte
  • Transition spørgsmål

Citer dette

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title = "How you evaluate treatment results in low back pain patients depends on who the patient is",
abstract = "BackgroundThe choice of an evaluative instrument in back pain patients is complicated because of lack of head-to-head comparisons of clinimetric properties of the various instruments. In addition, little is known about instrument behaviour in clinical subgroups. The objective of this study was to concurrently compare responsiveness and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients.MethodsThe Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0-10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP.ResultsRMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM=0.5-1.4; ROC=0.75-0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4-0.9; ROC = 0.76-0.89; RMQ: SRM = 0.3-0.9; ROC = 0.72-0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM=1.3-1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM=1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51{\%}) and RMQ (38{\%}) specifically and differed in the subpopulations.ConclusionsRMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for LBP patients with concurrent leg pain irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement.",
keywords = "Sp{\o}rgeskemaer, Undergrupper, Mindste kliniske relevante {\ae}ndring, Rygsmerter, Funktion, Smerte, Transition sp{\o}rgsm{\aa}l, Questionnaires, Subgroups, Minimal clinically important difference, Back pain, Function, Pain, Transition questions",
author = "Lauridsen, {Henrik Hein}",
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Lauridsen, HH 2009, How you evaluate treatment results in low back pain patients depends on who the patient is. i Proceedings. Forsknings- og Innovationsstyrelsen, s. 1, Forskningens Dag, Middelfart, Danmark, 30/04/2009.

How you evaluate treatment results in low back pain patients depends on who the patient is. / Lauridsen, Henrik Hein.

Proceedings. Forsknings- og Innovationsstyrelsen, 2009. s. 1.

Publikation: Bidrag til bog/antologi/rapport/konference-proceedingKonferenceabstrakt i proceedingsForskning

TY - ABST

T1 - How you evaluate treatment results in low back pain patients depends on who the patient is

AU - Lauridsen, Henrik Hein

PY - 2009

Y1 - 2009

N2 - BackgroundThe choice of an evaluative instrument in back pain patients is complicated because of lack of head-to-head comparisons of clinimetric properties of the various instruments. In addition, little is known about instrument behaviour in clinical subgroups. The objective of this study was to concurrently compare responsiveness and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients.MethodsThe Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0-10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP.ResultsRMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM=0.5-1.4; ROC=0.75-0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4-0.9; ROC = 0.76-0.89; RMQ: SRM = 0.3-0.9; ROC = 0.72-0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM=1.3-1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM=1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51%) and RMQ (38%) specifically and differed in the subpopulations.ConclusionsRMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for LBP patients with concurrent leg pain irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement.

AB - BackgroundThe choice of an evaluative instrument in back pain patients is complicated because of lack of head-to-head comparisons of clinimetric properties of the various instruments. In addition, little is known about instrument behaviour in clinical subgroups. The objective of this study was to concurrently compare responsiveness and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients.MethodsThe Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily pain subscales of the SF36, the Low Back Pain Rating Scale (LBPRS) and a numerical rating scale for pain (0-10) were completed by 191 patients from the primary and secondary sectors of the Danish health care system. Clinical change was estimated using a 7-point transition question and a numeric rating scale for importance. Responsiveness was operationalised using standardardised response mean (SRM), area under the receiver operating characteristic curve (ROC), and cut-point analysis. Subpopulation analyses were carried out on primary and secondary sector patients with LBP only or leg pain +/- LBP.ResultsRMQ was the most responsive instrument in primary and secondary sector patients with LBP only (SRM=0.5-1.4; ROC=0.75-0.94) whereas ODI and RMQ showed almost similar responsiveness in primary and secondary sector patients with leg pain (ODI: SRM = 0.4-0.9; ROC = 0.76-0.89; RMQ: SRM = 0.3-0.9; ROC = 0.72-0.88). In improved patients, the RMQ was more responsive in primary and secondary sector patients and LBP only patients (SRM=1.3-1.7) while the RMQ and ODI were equally responsive in leg pain patients (SRM=1.3 and 1.2 respectively). All pain measures demonstrated almost equal responsiveness. The MCID increased with increasing baseline score in primary sector and LBP only patients but was only marginally affected by patient entry point and pain location. The MCID of the percentage change score remained constant for the ODI (51%) and RMQ (38%) specifically and differed in the subpopulations.ConclusionsRMQ is suitable for measuring change in LBP only patients and both ODI and RMQ are suitable for LBP patients with concurrent leg pain irrespectively of patient entry point. The MCID is baseline score dependent but only in certain subpopulations. Relative change measured using the ODI and RMQ was not affected by baseline score when patients quantified an important improvement.

KW - Spørgeskemaer

KW - Undergrupper

KW - Mindste kliniske relevante ændring

KW - Rygsmerter

KW - Funktion

KW - Smerte

KW - Transition spørgsmål

KW - Questionnaires

KW - Subgroups

KW - Minimal clinically important difference

KW - Back pain

KW - Function

KW - Pain

KW - Transition questions

M3 - Conference abstract in proceedings

SP - 1

BT - Proceedings

PB - Forsknings- og Innovationsstyrelsen

ER -