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    Questionnaires to assess outcomes, functional limitations, and psychosocial factors

    Musculoskeletal (MSK) practitioners, including physiotherapists, osteopaths, and chiropractors, frequently use validated questionnaires to assess patient-reported outcomes, functional limitations, and psychosocial factors. These tools help guide treatment planning and evaluate the effectiveness of interventions. Below are several key questionnaires commonly used in clinical practice, supported by peer-reviewed research.

    1. Oswestry Disability Index (ODI)

    The Oswestry Disability Index is one of the most widely used tools for assessing disability in patients with low back pain. It evaluates the degree to which low back pain impacts daily activities like personal care, lifting, walking, sitting, and standing.

    • Use: Assess the functional limitations due to chronic low back pain.
    • Scoring: A higher score indicates greater disability.
    • Implications: Clinicians use this to track treatment progress and adjust interventions accordingly (Fairbank & Pynsent, 2000).

    2. Neck Disability Index (NDI)

    Similar to the ODI, the Neck Disability Index measures the impact of neck pain on daily activities. It assesses the intensity of pain and functional limitations, including driving, lifting, concentration, and recreation.

    • Use: Commonly used for patients with neck pain and cervical spine disorders.
    • Scoring: Higher scores indicate more severe disability.
    • Implications: The NDI helps practitioners gauge the severity of neck pain and the effectiveness of treatment interventions (MacDermid et al., 2009).

    3. Roland-Morris Disability Questionnaire (RMDQ)

    The RMDQ is designed to assess physical disability due to low back pain. It consists of 24 items that ask patients to identify activities they have difficulty performing due to pain.

    • Use: For patients with mild to moderate low back pain.
    • Scoring: Higher scores indicate greater physical disability.
    • Implications: The RMDQ is especially useful in primary care settings to evaluate changes in physical function over time (Roland & Fairbank, 2000).

    4. Patient-Specific Functional Scale (PSFS)

    The PSFS is a simple tool that allows patients to list up to five activities they find difficult to perform due to their condition. They then rate their ability to perform these activities on a scale from 0 to 10.

    • Use: It’s versatile and applicable to a wide range of musculoskeletal conditions.
    • Scoring: Improvement in scores indicates progress in function.
    • Implications: The PSFS is beneficial in creating individualized treatment plans based on patient-specific functional goals (Westaway et al., 1998).

    5. Short Form-36 Health Survey (SF-36)

    The SF-36 is a comprehensive measure that assesses overall health and well-being, covering physical functioning, role limitations due to physical or emotional problems, bodily pain, general health perceptions, and mental health.

    • Use: It is widely used in musculoskeletal conditions to assess the overall impact of a condition on health-related quality of life.
    • Scoring: Scores are provided for each domain, with higher scores indicating better health.
    • Implications: It allows practitioners to evaluate both physical and mental aspects of health in their patients (Ware & Sherbourne, 1992).

    6. Fear-Avoidance Beliefs Questionnaire (FABQ)

    The FABQ is used to measure patients’ fear of physical activity and work, which can exacerbate musculoskeletal conditions. This is particularly useful in understanding the psychosocial aspects of pain and disability.

    • Use: Helps identify patients who may develop chronic pain due to fear-avoidance behavior.
    • Scoring: Higher scores suggest higher levels of fear-avoidance, which may require cognitive-behavioral interventions.
    • Implications: The FABQ is especially useful for predicting poor outcomes in patients with low back pain (Waddell et al., 1993).

    7. Pain Catastrophizing Scale (PCS)

    The PCS assesses the degree to which patients catastrophize their pain experience. It focuses on rumination, magnification, and helplessness, factors that are linked to poor recovery and increased disability.

    • Use: Especially relevant in chronic pain conditions where psychological factors are significant.
    • Scoring: Higher scores indicate higher levels of catastrophizing, which can predict poor outcomes.
    • Implications: The PCS helps practitioners identify patients who may benefit from psychological interventions such as cognitive-behavioral therapy (Sullivan et al., 1995).

    8. Tampa Scale of Kinesiophobia (TSK)

    The TSK is used to assess fear of movement, particularly in patients who have experienced musculoskeletal injuries. Fear of re-injury often prevents patients from engaging in rehabilitation or physical activity.

    • Use: Commonly applied in the rehabilitation of patients with chronic musculoskeletal pain or after surgery.
    • Scoring: A higher score suggests greater kinesiophobia.
    • Implications: Clinicians can tailor interventions to address movement fears and promote rehabilitation adherence (Vlaeyen et al., 1995).

    9. Global Rating of Change (GROC)

    The GROC is a subjective tool where patients rate their overall improvement or deterioration over time. It is a quick assessment of treatment outcomes and patient satisfaction.

    • Use: Often used in conjunction with other functional outcome measures.
    • Scoring: Patients rate their change on a scale from -7 (a very great deal worse) to +7 (a very great deal better).
    • Implications: The GROC provides insight into how patients perceive their recovery and is useful in clinical audits and outcome research (Hurst & Bolton, 2004).

    Conclusion

    These questionnaires provide critical information for musculoskeletal practitioners to assess patient progress, evaluate functional limitations, and address psychosocial factors that may affect recovery. By using validated tools such as the ODI, NDI, FABQ, and PCS, practitioners can tailor interventions to better meet individual patient needs, ensuring evidence-based care.

    (Click to see some additional questionnaires)

    References:

    • Fairbank, J. C., & Pynsent, P. B. (2000). The Oswestry Disability Index. Spine, 25(22), 2940-2952.
    • MacDermid, J. C., Walton, D. M., & Avery, S. (2009). Measurement properties of the Neck Disability Index: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 39(5), 400-417.
    • Roland, M., & Fairbank, J. (2000). The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine, 25(24), 3115-3124.
    • Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524-532.
    • Waddell, G., Newton, M., & Henderson, I. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain, 52(2), 157-168.
    • Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473-483.
    • Westaway, M. D., Stratford, P. W., & Binkley, J. M. (1998). The Patient-Specific Functional Scale: Validation of its use in persons with neck dysfunction. Journal of Orthopaedic & Sports Physical Therapy, 27(5), 331-338.
    • Vlaeyen, J. W., Kole-Snijders, A. M., Boeren, R. G., & van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62(3), 363-372.
    • Hurst, H., & Bolton, J. (2004). Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative and Physiological Therapeutics, 27(1), 26-35.