People with LBP who are commencing multi-disciplinary care should be provided with validated multi-dimensional self-report questionnaires to use to help design their program, and measure and report progress.
Agency for Healthcare Research and Quality / National Guidelines Clearinghouse 2012. Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Available at: http://www.guideline.gov/
EXAMINATION – ACTIVITY LIMITATION AND PARTICIPATION RESTRICTION MEASURES: Clinicians should routinely assess activity limitation and participation restriction through validated performance-based measures. Changes in the patient’s level of activity limitation and participation restriction should be monitored with these same measures over the course of treatment. (Recommendation based on expert opinion.)
Low Back Pain: Medical Treatment Guidelines. July 2007. Department of Labor and Employment, State of Colorado, USA.
Functional assessment: Functional ability should be assessed and documented at the beginning of treatment. Periodic assessment should be recorded throughout the course of care to follow the trajectory of recovery. In addition to being more relevant to recovery from low back pain, functional measures are likely to be more reliable over time than pain measures. In one study of patients with lumbar spinal stenosis, functional measures such as the Oswestry Disability Index (ODI), the Swiss Spinal Stenosis Scale and the Patient Specific Functional Scale demonstrated test-retest reliability. Patient-reported outcomes, whether of pain or function, are susceptible to a phenomenon called response shift. This refers to changes in self-evaluation which may accompany changes in health status. Patient self-reports may not coincide with objective measures of outcome, such as straight leg raising, due to reconceptualization of the impact of pain on daily function and internal recalibration of pain scales. Response shift has potential to obscure treatment effects in clinical trials and clinical practice, and may lead to apparent discrepancies in patient-reported outcomes following treatment interventions. While methods of measuring and accounting for response shift are not yet fully developed, understanding that the phenomenon exists can help clinicians understand what is happening when some measures of patient progress appear inconsistent with other measures of progress.