Introduction
Review strategy
Patient-reported outcomes and outcome measures
Instrument | Outcome | Description |
---|---|---|
Oswestry Disability Index version 2.1a (ODI 2.1a) | Physical functioning | The ODI is a recommended condition-specific patient-reported outcome measure used to evaluate functional status in patients with back pain. It consists of 10 items: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life and travelling. |
24-item Roland Morris Disability Questionnaire (RMDQ-24) | Physical functioning | The RMDQ consists of 24 statements about activity limitations due to back pain, e.g. self-care and walking. |
Visual Analogue Scale (VAS) of back pain intensity and Pain Numerical Rating Scale (PNRS) | Pain | A VAS and PNRS ask the patient to rate pain from 0 to 10 (11 point scale) or from 0 to 100 (101 point scale) where 0 is equal to no pain and 10 or 100 is equal to worst possible pain. |
Short Form Health Survey 12 (SF-12) | Health-related quality of life | The SF-12 Health Survey is a 12-item questionnaire used to assess generic health outcomes from the patient’s perspective. |
Work Ability Index (WAI) | Work ability | The WAI is a validated instrument that assesses the individual work ability. Through a self-assessment questionnaire, the WAI measures a worker’s work ability and helps to define necessary measures for maintaining and promoting work ability, as it enables detecting work-related health risks as early as possible. |
Work Limitations Questionnaire (WLQ) | Work ability | The WLQ assesses the on-the-job impact of chronic health problems and/or treatment (work limitations). |
Canadian Occupational Performance Measure (COPM) | Activities of daily life, participation | The COPM is an individualized, client-centered outcome measure; designed to capture a patient’s self-perception of performance in everyday activities over time. |
Patient-reported outcomes in clinical trials
Patient-reported outcomes versus performance-based measurements of functioning
Outcomes and outcome measures related to non-pharmacological treatment in low back pain
Intervention | Guidelines | Level of evidence |
---|---|---|
Self-management | ||
Advice to stay active: maintaining usual levels of daily activity despite pain, including work [37] | Denmark [37]a,b | Low |
Germany [40] | Good to weak | |
UK [36] | Moderate to very low | |
USA_ACP [38]a,b | Not reported | |
USA_ICSI [39]a,b | Moderate | |
Patient education: regarding health literacy, competencies, and adaptation of behavior [37] | Denmark [37]a,b | Very low |
Germany [40] | Good to weak | |
UK [36] | Moderate to very low | |
USA_ACP [38]a,b | Not reported | |
USA_ICSI [39]a,b | High to moderate | |
Manual therapy | ||
Spinal manual therapy: any mobilization or spinal manipulation technique [37] | Denmark [37]a,b (in addition to usual care) | Low |
USA_ACP [38] | Low | |
USA_ICSI [39]a,b | Moderate to low | |
Manual therapy (spinal manipulation, mobilization or soft tissue techniques such as massage) in combination with exercise, with or without psychological therapy | UK [36] | High to very low |
Massage | USA_ACP [38]a,b | Low |
Exercise | ||
(Supervised) exercise: individualized exercises or physical activity (e.g. back-specific strengthening, stretching, motor control exercise or mobilizing exercises and cardiovascular training) delivered by a trained healthcare professional [37] | Denmark [37]a,b | Low |
USA_ACP [38]c | Moderate, motor control therapy: low | |
Movement therapy, including educative approach | Germany [40]b,c | Good to weak |
Group exercise | UK [36] | Moderate to very low |
USA_ACP [38]c | Moderate | |
Sport rehabilitation program or functional training (if the limitation in daily activities remains and the occupational rehabilitation is at risk) | Germany [40]b,c | Expert consensus |
Tai chi | USA_ACP [38]c | Low |
Yoga | USA_ACP [38]c | Low |
Psychological therapy and/or interventions | ||
Psychological therapy (using a cognitive behavioral approach) in combination with other treatments (e.g. exercise, manual therapy) or a multimodal program | Germany [40]c | Good to weak |
UK [36] | Moderate to very low | |
Cognitive behavioral therapy | Germany [40]b (if psycho-social risk factors exist) | Weak |
USA_ACP [38]c | Low | |
Operant therapy | USA_ACP [38]c | Low |
Mindfulness-based stress reduction | USA_ACP [38]c | Moderate |
Progressive relaxation | Germany [40]c | Weak |
USA_ACP [38]c | Low | |
Multidisciplinary programs | ||
Multidisciplinary rehabilitation: combines a physical and psychological program | UK [36] (if significant psychosocial obstacles to recovery exist or previous treatments have not been effective) | Moderate to very low |
USA_ACP [38]c | Moderate | |
Return to work | ||
Return to work programs (work or normal activities of daily living) | UK [36] | High to very low |
Acupuncture | ||
Acupuncture | USA_ACP [38] | Lowa, b, moderatec |
USA_ICSI [39]a,b | Low | |
Biofeedback, laser therapy | ||
Electromyography biofeedback | USA_ACP [38]c | Low |
Low-level laser therapy | USA_ACP [38]c | Low |
Others | ||
Superficial heat | USA_ACP [38]a,b | Moderate |
USA_ICSI [39]a,b | Moderate | |
Cryotherapy | USA_ICSI [39]a,b | Expert consensus |
Intervention | Guidelines |
---|---|
Manual therapy | |
Massage | Germany [40]* |
Traction | UK [36] |
Motorized traction | Germany [40] |
Work hardening | |
Work hardening/work conditioning | Germany [40]* |
Acupuncture | |
Acupuncture | Denmark [37] |
UK [36] | |
Ultrasound, electrotherapies, laser therapy, magnet therapy, diathermy | |
Ultrasound | Germany [40] |
UK [36] | |
Transcutaneous electrical nerve stimulation (TENS) | Germany [40]*,+ |
UK [36] | |
Percutaneous electrical nerve stimulation (PENS) | Germany [40] |
UK [36] | |
Interferential therapy | Germany [40] |
UK [36] | |
Laser therapy | Germany [40] |
Magnet therapy | Germany [40] |
Short-wave diathermy | Germany [40] |
Others | |
Cryotherapy | Germany [40] |
Orthotics (such as belts, corsets, foot orthotics, rocker sole shoes) | Germany [40], specifically (foot) orthotics |
UK [36] | |
Kinesio taping | Germany [40] |