Outcome measures in chronic low back pain
Open accessAbstract
The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a "successful" outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution- and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution.
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The minimum clinically important differences in pain scores before and after treatment are reported to range from 1.50 to 3.20 points.
“The minimum clinically important differences in pain scores before and after treatment are reported to range from 1.50 to 3.20 points [37,38].”
From The Effect of Osteopathic Manipulative Treatment Adjunct on Stabilization Splint Treatment in Temporomandibular Joint Anterior Disc Displacement with Reduction Disorder: A Quantitative Analysis, Pilot Study (2025) · cites this paper as [38]
The Discussion reports clinically important changes in pain scores, but not the stated 1.50–3.20-point range. For the numerical pain rating scale, it gives 2.4 points using a distribution-based method and 4 points using an anchor-based method, and notes that the value depends on the method used. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe minimal clinically important difference for pain has been reported to range from 1.5 to 3.2 points.
“The minimal clinically important difference for pain has been reported to range from 1.5 to 3.2 points.30 -34”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [33]
The Discussion reports a minimal clinically important change of 4 points on the pain numerical rating scale, while the Abstract also gives a method-dependent estimate of 2.4 points. The paper therefore supports the existence of a point-based pain threshold, but not the claimed range of 1.5–3.2 points; its 4-point estimate falls outside it. (LLM, conf=0.87)
Experimental — accuracy not yet measuredTwo studies of the PSEQ in people with low back pain suggest that a change of greater than 5.5 or 8.5 points constitutes a minimal clinically important difference (MCID).
“However, two studies of the PSEQ in people with low back pain suggest a change of greater than 5.5 20 or 8.5 21 points constitutes a MCID.”
From A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person (2023) · cites this paper as [21]
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- Authors
- Maughan, E. F., & Lewis, J. S.
- Affiliations
- Guy's Hospital (GB)
- St George's, University of London (GB)
- Corresponding author
- Maughan, Elaine F.
- ORCID
- Lewis, Jeremy S.
- Venue
- European Spine Journal
- Published
- 2010-04-17
- Volume
- 19
- Issue
- 9
- Pages
- 1484-1494
- ISSN
- 0940-6719 (ISSN-L)
- 1432-0932
- PMC
- PMC2989277
- OpenAlex
- W2090368954
- Cited by
- 438
- References
- 59
- Citations by year
- 2026: 20 · 2025: 42 · 2024: 46 · 2023: 31 · 2022: 38 · 2021: 42 · 2020: 30 · 2019: 38 · 2018: 24 · 2017: 21 · 2016: 21 · 2015: 28 · 2014: 13 · 2013: 20 · 2012: 12
- FWCI
- 10.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Spine Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- chronic low back pain, outcome measures, minimal clinically important difference, numerical rating scale, Roland-Morris Disability Questionnaire, Oswestry Disability Index, Pain Self-Efficacy Questionnaire, Patient-Specific Functional Scale, responsiveness to change, global impression of change, standard error of measurement, ROC curve, disability assessment, pain self-efficacy
- MeSH terms
- Adult, Aged, Chronic Disease, Disability Evaluation, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, ROC Curve, Treatment Outcome, Outcome Assessment, Health Care, Low Back Pain, Area Under Curve, Recovery of Function
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