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Outcome Assessment
Questionnaires
This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
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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.
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Outcome Assessment Questionnaires need to be sensitive to 3 criteria:
Validity: The degree to which an instrument measures what it is supposed to measure.
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.
Responsiveness: An instrument's ability to detect change over time.
The following questionnaires have been tested for accurately measuring all 3 criteria.
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Articles about Outcome Questionnaires
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The Outcome Assessment Guidelines
A Chiro.Org article collection
These National Guidelines come from a variety of sources.
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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.
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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
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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.
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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.
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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
NCT01539863
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.
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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.
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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
NCT01539863
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.
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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.
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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.
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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.
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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.
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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].
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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.
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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.
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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.
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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”).
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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]
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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."
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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
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Functional Outcome Questionnaires
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The RAND 36-Item Short Form Health Survey (SF-36)
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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.
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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.
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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.
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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.
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The Neck Disability Index (NDI)
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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).
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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.
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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.
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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.
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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.
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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.
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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.
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The Oswestry Low Back Pain Questionnaire (OLB)
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The Bournemouth Back and Neck Questionnaires
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The Functional Rating Index (FRI)
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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.
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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"
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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.
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The Quadruple Visual Analogue Scale (VAS)
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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.
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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.
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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.
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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.
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Patient Global Impression of Change
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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.
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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.
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The McGill Pain Questionnaire
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The Copenhagen Neck Disability Scale
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The Roland–Morris Questionnaire
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Measure Yourself Medical Outcome Profile (MYMOP)
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The Patient-Specific Functional Scale
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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
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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]
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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.
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Migraine Disability Assessment (MIDAS)
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Headache Impact Test (HIT-6)
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Psychosocial Outcome Questionnaires
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The Pain Catastrophizing Scale
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The Pain Catastrophizing Scale
@Oregon.Gov
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.
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Pain Catastrophizing Scale
Physiopedia
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.
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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.
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Major Depression Inventory (MDI)
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Major Depression Inventory (MDI) PDF
This document contains the questionnaire, scoring methodology and other scoring instructions.
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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.
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The Questionnaire for Assessing Psychosocial Yellow Flags
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The NeckPix(©) Tool for Assessing Kinesiophobia
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Fear Avoidance Beliefs Questionnaire (FABQ)
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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.
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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.
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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.
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The Tampa Scale of Kinesiophobia (TSK)
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Patient Satisfaction Questionnaires
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| Visit-Specific Satisfaction Instrument (VSQ-9)
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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
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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.
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Quality of Life Questionnaires
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Patient Reported Outcomes Measurement Information System (PROMIS)
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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.
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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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Since 3–01–1998
Updated 2-05-2024
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