Content comparison of questionnaires and scales used in low back pain based on the international classification of functioning, disability and health: a systematic review

Abstract

Purpose: To identify questionnaires and scales that measure functioning and disability in low-back pain (LBP) and determine whether the measurements are comparable with the International Classification of Functioning, Disability and Health (ICFDH). Methods: We searched MEDLINE, EMBase, CINAHL and PEDro in English, and CNKI and Wanfang Data in Chinese in a period from the date of the database establishment to September 2010. From the identified literature, questionnaires and scales used to assess LBP-related functioning and disability were collected and classified. Each item in each questionnaire and scale was extracted and classified according to the ICFDH categories. Results: We have reviewed 7968 published articles and identified a total of fifteen questionnaires. A total of 219 items were analyzed and a total of 354 concepts contained in these items and 345 could be linked to ICFDH components, 138 linked to body function, 20 to body structure, 174 to activities and participation, and 13 to environmental factors, and 9 to a non-classifiable cluster. In the body functions component, only the single category “sensation of pain” was covered by most questionnaires. In the activity and participation component, “changing basic body position”; ”walking” and “maintaining a body position” were covered by most questionnaires. Analyzing individual questionnaires, we found that two questionnaires (Clinical Back Pain Questionnaire and Million Disability Questionnaire) demonstrate a well-balanced distribution of items across different ICFDH components. Conclusion: This study may help researchers and clinicians to choose the most appropriate questionnaires for a specific purpose as well as help compare studies that have used different questionnaires for low back pain assessment and provide valuable information on the content quality of these questionnaires for them. Furthermore, based on our results, more comprehensive and balanced instruments may be developed for more accurate assessment of functioning in LBP and perhaps other clinical conditions.

Implications for Rehabiliation

• Low back pain (LBP) is the most common cause of referral to a physical therapist and is one of the most important causes of disability.

• The ICFDH is based on the bio-psycho-social model of functioning, disability and health and offers a detailed and etiologically neutral classification.

• Content comparison may help clinicians to choose the most appropriate questionnaires.

Keywords::

• International classification of Functioning
• Disability and Health
• low-back pain

Acknowledgement

We would like to thank the reviewers for their helpful comments on this manuscript. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Declaration of Interest: The authors report no conflicts of interest.