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Cited by 114Musculoskeletal pain and rehabilitationHealth Systems, Economic Evaluations, Quality of LifeMedical Practices and Rehabilitation

Responsiveness of general health status in chronic low back pain: a comparison of the COOP charts and the SF-36

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Bronfort, Gert, Bouter, Lex M·1999·Pain
DOI 10.1016/s0304-3959(99)00103-7
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Abstract

The objective of this study was to compare the responsiveness and assess the concurrent validity of two functional health status instruments, the Dartmouth COOP charts and the SF-36 in chronic low-back pain (CLBP) patients. The data came from 129 of 174 patients who participated in a randomized clinical trial of the therapeutic management of CLBP. Reliable and valid disease-specific outcomes, patient-rated low-back pain and disability, were used as external criteria (EC) to identify improved and non-improved patients. Unpaired t-statistics and receiver operating characteristic (ROC) curve calculations were used to quantify responsiveness. The two instruments had sufficient and very similar responsiveness using both EC. Comparisons between improved and non-improved patients for the COOP charts and SF-36, respectively, using pain as EC, yielded differences which translated into large effect sizes (0.8 and 0.7) (P=0.0008 and 0.003). Using disability as EC, differences of moderate effect size were found (0.5 and 0.6) (P=0.02 and 0.002). The ROC curve calculations using pain as EC resulted in areas under the curve of 0.76 (95% CI: 0.64, 0.88) for the COOP charts, and 0.74 (95% CI: 0.60, 0.88) for the SF-36. The corresponding areas using disability as EC were 0.67 (95% CI: 0.55, 0.79) and 0.72 (95% CI: 0.60, 0.84). The best cut-off point in both instruments for differentiating between improved and non-improved patients was approximately six percentage points. The constructs of functional health status, as reflected in the global scores of the two instruments, are highly correlated (r=0.82). Six of the instruments' nine dimensions are moderately to highly correlated (r=0.52 to 0.86), and the overall canonical correlation was high (R=0.9). In conclusion, both instruments seem equally suitable for use as outcome measures in clinical trials on CLBP. The COOP charts are faster to fill out and score.

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Authors
Bronfort, G., & Bouter, L. M.
Affiliations
Vrije Universiteit Amsterdam (NL)
ORCID
Bouter, Lex M
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1999-11
Volume
83
Issue
2
Pages
201-209
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/s0304-3959(99)00103-7
OpenAlex
W2090568934
Cited by
114
References
49
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 7 · 2015: 3 · 2014: 3 · 2013: 1 · 2012: 5
FWCI
3.89
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
chronic low back pain, SF-36, responsiveness, concurrent validity, functional status, patient-reported outcome measures, disability, outcome measure comparison, clinical trial outcome measures
MeSH terms
Adult, Anti-Inflammatory Agents, Non-Steroidal, Chronic Disease, Exercise Therapy, Female, Health Status, Humans, Male, Middle Aged, Pain Measurement, ROC Curve, Sensitivity and Specificity, Low Back Pain, Manipulation, Spinal

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