Evaluating common outcomes for measuring treatment success for chronic low back pain

Jens R. Chapman, Daniel C. Norvell, Jeffrey T. Hermsmeyer, Richard J. Bransford, John Glenden DeVine, Matthew J. McGirt, Michael J. Lee

Research output: Contribution to journalReview article

219 Citations (Scopus)

Abstract

Study Design.: Systematic review. Objective.: To identify, describe, and evaluate common outcome measures in patients with chronic low back pain (CLBP). Summary of Background DATA.: The treatment of CLBP has been associated with multiple clinical challenges. Further complicating this is the myriad of outcome scores used to assess treatment of CLBP. These scores have been used to examine different domains of patient satisfaction and quality of life in the literature. Critical assessment of the frequency, parity, and the quality of these outcomes are essential to improve our understanding of CLBP. Methods.: A systematic review of the English-language literature was undertaken for articles published from January 2001 through December 31, 2010. Electronic databases and reference lists of key articles were searched to identify measures used to evaluate outcomes in six different domains in patients with CLBP. The titles and abstracts of the peer-reviewed literature of LBP were searched to determine which of these measures were most commonly reported in the literature and which have been validated in populations with CLBP. Results.: We identified 75 outcome measures cited to evaluate CLBP. Twenty-nine of these outcome measures were excluded because of only a single citation leaving 46 measures for the evaluation. The most commonly used functional outcomes were the Oswestry Disability Index, Roland Morris Disability Index, and range of motion. For pain, the Numeric Pain Rating Scale, Brief Pain Inventory, Pain Disability Index, McGill Pain Questionnaire, and visual analog scale were most commonly cited. For psychosocial function, the Fear Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, and Beck Depression Inventory were most commonly used. For generic quality of life, short form 36, Nottingham Health Profile, short form 12, and Sickness Impact Profile were the most common measures. For objective measures, the work status/return to work, complications or adverse events, and medications used were the most commonly cited. For preference-based measures, the Euro-Quol 5 dimensions and short form 6 dimensions were most commonly cited. The validity, reliability, responsiveness, universality, and potential proprietary requirements are summarized for each. Conclusion.: Outcome measures should be routinely assessed in patients with CLBP. The choice of appropriate outcome measure should be influenced by the study objectives and design, as well as properties of the particular measure within the context of CLBP. Clinical Recommendations.: Recommendation 1: When selecting the appropriate outcome measures for clinical or research purposes, consider domains that best measure what are most important to patients. Measures that are valid, reliable, and responsive to change should be considered first. Other considerations include the number of items required (especially in the context of multiple measures), whether the measure is validated in the relevant language, and the associated costs or fees. Strength: StrongRecommendation 2: Domains of greatest importance include pain, function, and quality of life. If cost utilization is a priority, then preference-based measures should be considered. For pain, we recommend the VAS and NRPS because of their ease of administration and responsiveness. For function, we recommend the ODI and RMDQ. The SF-36 and its shorter versions are most commonly used and should be considered if quality of life is important. If cost utility is important, consider the EQ-5D or SF-6D. Psychosocial tests are best used as screening tools prior to surgery because of their lack of responsiveness. Complications should always be assessed as a standard of clinical practice. Return to work and medication use are complicated outcome measures and not recommended unless the specific study question is focused on these domains. Consider staff and patient burden when prioritizing one's battery of measures.

Original languageEnglish (US)
JournalSpine
Volume36
Issue number21 SUPPL.
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Low Back Pain
Outcome Assessment (Health Care)
Pain
Quality of Life
Return to Work
Costs and Cost Analysis
Language
Sickness Impact Profile
Equipment and Supplies
Fees and Charges
Pain Measurement
Articular Range of Motion
Parity
Visual Analog Scale
Patient Satisfaction
Reproducibility of Results
Fear
Databases
Depression
Health

Keywords

  • chronic low back pain
  • outcomes
  • patient-reported
  • reliability
  • responsiveness
  • spine surgery
  • validity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Chapman, J. R., Norvell, D. C., Hermsmeyer, J. T., Bransford, R. J., DeVine, J. G., McGirt, M. J., & Lee, M. J. (2011). Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine, 36(21 SUPPL.). https://doi.org/10.1097/BRS.0b013e31822ef74d

Evaluating common outcomes for measuring treatment success for chronic low back pain. / Chapman, Jens R.; Norvell, Daniel C.; Hermsmeyer, Jeffrey T.; Bransford, Richard J.; DeVine, John Glenden; McGirt, Matthew J.; Lee, Michael J.

In: Spine, Vol. 36, No. 21 SUPPL., 01.10.2011.

Research output: Contribution to journalReview article

Chapman, JR, Norvell, DC, Hermsmeyer, JT, Bransford, RJ, DeVine, JG, McGirt, MJ & Lee, MJ 2011, 'Evaluating common outcomes for measuring treatment success for chronic low back pain', Spine, vol. 36, no. 21 SUPPL.. https://doi.org/10.1097/BRS.0b013e31822ef74d
Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine JG, McGirt MJ et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine. 2011 Oct 1;36(21 SUPPL.). https://doi.org/10.1097/BRS.0b013e31822ef74d
Chapman, Jens R. ; Norvell, Daniel C. ; Hermsmeyer, Jeffrey T. ; Bransford, Richard J. ; DeVine, John Glenden ; McGirt, Matthew J. ; Lee, Michael J. / Evaluating common outcomes for measuring treatment success for chronic low back pain. In: Spine. 2011 ; Vol. 36, No. 21 SUPPL.
@article{9606e5d726874cf0902a188d38c353f3,
title = "Evaluating common outcomes for measuring treatment success for chronic low back pain",
abstract = "Study Design.: Systematic review. Objective.: To identify, describe, and evaluate common outcome measures in patients with chronic low back pain (CLBP). Summary of Background DATA.: The treatment of CLBP has been associated with multiple clinical challenges. Further complicating this is the myriad of outcome scores used to assess treatment of CLBP. These scores have been used to examine different domains of patient satisfaction and quality of life in the literature. Critical assessment of the frequency, parity, and the quality of these outcomes are essential to improve our understanding of CLBP. Methods.: A systematic review of the English-language literature was undertaken for articles published from January 2001 through December 31, 2010. Electronic databases and reference lists of key articles were searched to identify measures used to evaluate outcomes in six different domains in patients with CLBP. The titles and abstracts of the peer-reviewed literature of LBP were searched to determine which of these measures were most commonly reported in the literature and which have been validated in populations with CLBP. Results.: We identified 75 outcome measures cited to evaluate CLBP. Twenty-nine of these outcome measures were excluded because of only a single citation leaving 46 measures for the evaluation. The most commonly used functional outcomes were the Oswestry Disability Index, Roland Morris Disability Index, and range of motion. For pain, the Numeric Pain Rating Scale, Brief Pain Inventory, Pain Disability Index, McGill Pain Questionnaire, and visual analog scale were most commonly cited. For psychosocial function, the Fear Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, and Beck Depression Inventory were most commonly used. For generic quality of life, short form 36, Nottingham Health Profile, short form 12, and Sickness Impact Profile were the most common measures. For objective measures, the work status/return to work, complications or adverse events, and medications used were the most commonly cited. For preference-based measures, the Euro-Quol 5 dimensions and short form 6 dimensions were most commonly cited. The validity, reliability, responsiveness, universality, and potential proprietary requirements are summarized for each. Conclusion.: Outcome measures should be routinely assessed in patients with CLBP. The choice of appropriate outcome measure should be influenced by the study objectives and design, as well as properties of the particular measure within the context of CLBP. Clinical Recommendations.: Recommendation 1: When selecting the appropriate outcome measures for clinical or research purposes, consider domains that best measure what are most important to patients. Measures that are valid, reliable, and responsive to change should be considered first. Other considerations include the number of items required (especially in the context of multiple measures), whether the measure is validated in the relevant language, and the associated costs or fees. Strength: StrongRecommendation 2: Domains of greatest importance include pain, function, and quality of life. If cost utilization is a priority, then preference-based measures should be considered. For pain, we recommend the VAS and NRPS because of their ease of administration and responsiveness. For function, we recommend the ODI and RMDQ. The SF-36 and its shorter versions are most commonly used and should be considered if quality of life is important. If cost utility is important, consider the EQ-5D or SF-6D. Psychosocial tests are best used as screening tools prior to surgery because of their lack of responsiveness. Complications should always be assessed as a standard of clinical practice. Return to work and medication use are complicated outcome measures and not recommended unless the specific study question is focused on these domains. Consider staff and patient burden when prioritizing one's battery of measures.",
keywords = "chronic low back pain, outcomes, patient-reported, reliability, responsiveness, spine surgery, validity",
author = "Chapman, {Jens R.} and Norvell, {Daniel C.} and Hermsmeyer, {Jeffrey T.} and Bransford, {Richard J.} and DeVine, {John Glenden} and McGirt, {Matthew J.} and Lee, {Michael J.}",
year = "2011",
month = "10",
day = "1",
doi = "10.1097/BRS.0b013e31822ef74d",
language = "English (US)",
volume = "36",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "21 SUPPL.",

}

TY - JOUR

T1 - Evaluating common outcomes for measuring treatment success for chronic low back pain

AU - Chapman, Jens R.

AU - Norvell, Daniel C.

AU - Hermsmeyer, Jeffrey T.

AU - Bransford, Richard J.

AU - DeVine, John Glenden

AU - McGirt, Matthew J.

AU - Lee, Michael J.

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Study Design.: Systematic review. Objective.: To identify, describe, and evaluate common outcome measures in patients with chronic low back pain (CLBP). Summary of Background DATA.: The treatment of CLBP has been associated with multiple clinical challenges. Further complicating this is the myriad of outcome scores used to assess treatment of CLBP. These scores have been used to examine different domains of patient satisfaction and quality of life in the literature. Critical assessment of the frequency, parity, and the quality of these outcomes are essential to improve our understanding of CLBP. Methods.: A systematic review of the English-language literature was undertaken for articles published from January 2001 through December 31, 2010. Electronic databases and reference lists of key articles were searched to identify measures used to evaluate outcomes in six different domains in patients with CLBP. The titles and abstracts of the peer-reviewed literature of LBP were searched to determine which of these measures were most commonly reported in the literature and which have been validated in populations with CLBP. Results.: We identified 75 outcome measures cited to evaluate CLBP. Twenty-nine of these outcome measures were excluded because of only a single citation leaving 46 measures for the evaluation. The most commonly used functional outcomes were the Oswestry Disability Index, Roland Morris Disability Index, and range of motion. For pain, the Numeric Pain Rating Scale, Brief Pain Inventory, Pain Disability Index, McGill Pain Questionnaire, and visual analog scale were most commonly cited. For psychosocial function, the Fear Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, and Beck Depression Inventory were most commonly used. For generic quality of life, short form 36, Nottingham Health Profile, short form 12, and Sickness Impact Profile were the most common measures. For objective measures, the work status/return to work, complications or adverse events, and medications used were the most commonly cited. For preference-based measures, the Euro-Quol 5 dimensions and short form 6 dimensions were most commonly cited. The validity, reliability, responsiveness, universality, and potential proprietary requirements are summarized for each. Conclusion.: Outcome measures should be routinely assessed in patients with CLBP. The choice of appropriate outcome measure should be influenced by the study objectives and design, as well as properties of the particular measure within the context of CLBP. Clinical Recommendations.: Recommendation 1: When selecting the appropriate outcome measures for clinical or research purposes, consider domains that best measure what are most important to patients. Measures that are valid, reliable, and responsive to change should be considered first. Other considerations include the number of items required (especially in the context of multiple measures), whether the measure is validated in the relevant language, and the associated costs or fees. Strength: StrongRecommendation 2: Domains of greatest importance include pain, function, and quality of life. If cost utilization is a priority, then preference-based measures should be considered. For pain, we recommend the VAS and NRPS because of their ease of administration and responsiveness. For function, we recommend the ODI and RMDQ. The SF-36 and its shorter versions are most commonly used and should be considered if quality of life is important. If cost utility is important, consider the EQ-5D or SF-6D. Psychosocial tests are best used as screening tools prior to surgery because of their lack of responsiveness. Complications should always be assessed as a standard of clinical practice. Return to work and medication use are complicated outcome measures and not recommended unless the specific study question is focused on these domains. Consider staff and patient burden when prioritizing one's battery of measures.

AB - Study Design.: Systematic review. Objective.: To identify, describe, and evaluate common outcome measures in patients with chronic low back pain (CLBP). Summary of Background DATA.: The treatment of CLBP has been associated with multiple clinical challenges. Further complicating this is the myriad of outcome scores used to assess treatment of CLBP. These scores have been used to examine different domains of patient satisfaction and quality of life in the literature. Critical assessment of the frequency, parity, and the quality of these outcomes are essential to improve our understanding of CLBP. Methods.: A systematic review of the English-language literature was undertaken for articles published from January 2001 through December 31, 2010. Electronic databases and reference lists of key articles were searched to identify measures used to evaluate outcomes in six different domains in patients with CLBP. The titles and abstracts of the peer-reviewed literature of LBP were searched to determine which of these measures were most commonly reported in the literature and which have been validated in populations with CLBP. Results.: We identified 75 outcome measures cited to evaluate CLBP. Twenty-nine of these outcome measures were excluded because of only a single citation leaving 46 measures for the evaluation. The most commonly used functional outcomes were the Oswestry Disability Index, Roland Morris Disability Index, and range of motion. For pain, the Numeric Pain Rating Scale, Brief Pain Inventory, Pain Disability Index, McGill Pain Questionnaire, and visual analog scale were most commonly cited. For psychosocial function, the Fear Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, and Beck Depression Inventory were most commonly used. For generic quality of life, short form 36, Nottingham Health Profile, short form 12, and Sickness Impact Profile were the most common measures. For objective measures, the work status/return to work, complications or adverse events, and medications used were the most commonly cited. For preference-based measures, the Euro-Quol 5 dimensions and short form 6 dimensions were most commonly cited. The validity, reliability, responsiveness, universality, and potential proprietary requirements are summarized for each. Conclusion.: Outcome measures should be routinely assessed in patients with CLBP. The choice of appropriate outcome measure should be influenced by the study objectives and design, as well as properties of the particular measure within the context of CLBP. Clinical Recommendations.: Recommendation 1: When selecting the appropriate outcome measures for clinical or research purposes, consider domains that best measure what are most important to patients. Measures that are valid, reliable, and responsive to change should be considered first. Other considerations include the number of items required (especially in the context of multiple measures), whether the measure is validated in the relevant language, and the associated costs or fees. Strength: StrongRecommendation 2: Domains of greatest importance include pain, function, and quality of life. If cost utilization is a priority, then preference-based measures should be considered. For pain, we recommend the VAS and NRPS because of their ease of administration and responsiveness. For function, we recommend the ODI and RMDQ. The SF-36 and its shorter versions are most commonly used and should be considered if quality of life is important. If cost utility is important, consider the EQ-5D or SF-6D. Psychosocial tests are best used as screening tools prior to surgery because of their lack of responsiveness. Complications should always be assessed as a standard of clinical practice. Return to work and medication use are complicated outcome measures and not recommended unless the specific study question is focused on these domains. Consider staff and patient burden when prioritizing one's battery of measures.

KW - chronic low back pain

KW - outcomes

KW - patient-reported

KW - reliability

KW - responsiveness

KW - spine surgery

KW - validity

UR - http://www.scopus.com/inward/record.url?scp=80053418337&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053418337&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e31822ef74d

DO - 10.1097/BRS.0b013e31822ef74d

M3 - Review article

VL - 36

JO - Spine

JF - Spine

SN - 0362-2436

IS - 21 SUPPL.

ER -