OUTCOME ASSESSMENT QUESTIONNAIRES
 
   

Outcome Assessment
Questionnaires

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

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Dear Readers:   The Outcome Forms actually stored on our server have been approved for your use by the owners (or copyright holders). If you plan to use them for commercial use, research, or publication, please Google those owners, and ask them for permission.   I can not do that for you.   The QAs that we “link to” (that are located on other websites) are ones we couldn't get permission for.

I have provided scoring/grading methods with the questionnaires whenever they have been available.   If you utilize these QAs in patient care, you will need those scoring methodologies. I strongly recommend that you purchase Yeoman's The Clinical Application of Outcomes Assessment from Amazon, to get all that information.

The best way to copy a Word or Adobe Acrobat (PDF) file from this page is to follow this procedure:Right-click” the URL (or link), and then select “Save Target As”, then choose the “directory” (in your computer) that you want to save it to.   When the item is saved, then select “open file”.   Adobe Acrobat files open and print much better when they reside within your own computer, especially with the larger documents.





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   Outcome Assessment Guidelines
Review these recommendations for Outcome Assessment by a variety of National associations.


   The Outcome Assessment Book Shelf
Please browse our Outcome Assessment book shelf.
Any books you purchase will help to support our non-commercial website.


   View a Powerpoint Presentation on Outcome Assessment
Thanks to Dr. Steve Yeomans and the ACRB for the use of this file!
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Outcome Assessment Questionnaires need to be sensitive to 3 criteria:

  1. Validity:   The degree to which an instrument measures what it is supposed to measure.

  2. Reliability:   The degree to which an instrument can produce consistent results, and consistent results on different occasions, even when there is no evidence of change.

  3. Responsiveness:   An instrument's ability to detect change over time.

The following QAs have been tested and validated for accurately measuring all 3 criteria.

 
   

Functional Outcome Questionnaires
 
   

   The RAND 36-Item Short Form Health Survey   (SF-36)   


Rand SF-36 ~   in Word  or    as Adobe Acrobat
As part of the Medical Outcomes Study (MOS) — a multi-year, multi-site study to explain variations in patient outcomes — RAND developed the 36-Item Short Form Health Survey (SF-36).   SF-36 is a set of generic, coherent, and easily administered quality-of-life measures.   These measures rely upon patient self-reporting and are now widely utilized by managed care organizations and by Medicare for routine monitoring and assessment of care outcomes in adult patients.   Before downloading the SF-36 you must read Rand's Disclaimer.   This document is formatted to print on both sides of a page, with a larger border on the left-hand side for binding into a file.
   Download The Adobe Acrobat Reader for Free


How to score the SF-36 ~   in Word  or    as Adobe Acrobat  or
as a Web Page Document (HTML)
These pages takes you on a step–by–step method for scoring the Rand–36.


Scoring Page for SF-36 ~   in Word  or    as Adobe Acrobat  or
as a Web Page Document (HTML)
This page is for tallying the score from the Rand–36 and can be stored in the patient file.


Measuring Functional Health Status in the Chiropractic Office
Using Self-Report Questionnaires

Topics in Clinical Chiropractic 1994:   1 (1):   51-59 ~ FULL TEXT

The questionnaire is located on page 81-83.
Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of impending change toward more closely managed health care purchasing, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economic and efficient way of accomplishing the task. Two such instruments are presented in detail: the Dartmouth COOP charts and the RAND 36-Item Health Survey 1.0, the latter of which is included in its entirety for use in the office setting. Several other instruments are briefly summarized.


Responsiveness of the Cervical Northern American Spine Society Questionnaire
(NASS) and the Short Form 36 (SF-36) in Chronic Whiplash

Clin Rehabil. 2011 (Aug 19) [Epub ahead of print]

The generic SF-36 was more responsive in function and equally responsive in pain when compared to the condition-specific NASS. The SF-36 can be recommended as a responsive instrument for measurement of pain and function in chronic whiplash syndrome.


Development of an Index of Physical Functional Health Status in Rehabilitation
Arch Phys Med Rehabil 2002 (May);   83 (5):   655–665

Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.

 
   

   The Neck Disability Index   (NDI)   


Neck Disability Index (NDI) ~   in Word  or    as Adobe Acrobat
This modified Oswestry questionnaire is a 2 sided form....with a pain diagram on the second side.   The borders are alligned so you can make it into a two-sided sheet, which can be side-punched (on the 11" side) and put into the patient file.


Scoring Methodology/comments by Howard Vernon, D.C.
The scoring method also available in  Adobe Acrobat (8KB).


The Neck Disability Index: State-of-the-Art, 1991-2008
J Manipulative Physiol Ther 2008 (Sep);   31 (7):   491–502

The NDI has been translated into 22 languages, with 6 published reports and 1 large Web-based resource with 18 readily available versions. It has been used in 52 surgical clinical trials and 3 trials of injection therapies as well as RCTs of numerous conservative therapies, chiefly manipulation and exercise. In this regard, it has served to expand the range of outcome measurements of neck pain patients beyond the limited use of pain scales and has enriched the yield of these clinical trials.


Comparison of the Neck Disability Index and the Neck Bournemouth
Questionnaire in a Sample of Patients with Chronic Uncomplicated Neck Pain

J Manipulative Physiol Ther 2007 (May);   30 (4):   259–262

The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain. Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain. Both had acceptable internal consistency and are appropriate for use as single-outcome scales.


The Neck Disability Index: A Study of Reliability and Validity
J Manipulative Physiol Ther 1991 (Sep);   14 (7):   409–415

Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number. A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI).While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.

 
   

   The Oswestry Low Back Pain Questionnaire   


Oswestry Low Back Pain ~   in Word  or    in Adobe Acrobat
This questionnaire is the J. Fairbanks QA from the journal Physiotherapy 1980; 66: 271, and comes with a second page, containing a pain drawing. Please note that the scoring methodology is the same as with the NDI.


Scoring Methodology
The scoring method also available in  Adobe Acrobat (8KB).


The Oswestry Disability Index
SPINE (Phila Pa 1976) 2000 (Nov 15);   25 (22):   2940–2952

The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

 
   

   The Bournemouth Back and Neck Questionnaires   


Bournemouth Back
Adobe Acrobat version.   No scoring method is available on our website


The Bournemouth Questionnaire: A Short-form Comprehensive Outcome Measure.
I. Psychometric Properties in Back Pain Patients

J Manipulative Physiol Ther 1999 (Oct);   22 (8):   503-510

Seven dimensions of the back pain model were included in the questionnaire. Having established face validity, the instrument was shown to demonstrate high internal consistency (Cronbach's ALPHA = 0.9) and good test-retest reliability (ICC = 0.95). All items were retained on the basis that they contributed to the overall score (item-corrected total score correlations) and to the instrument's responsiveness to clinical change (item change-corrected total change score correlations). The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures. The effect size of the instrument was high (1.29) and comparable with established measures.



Bournemouth Neck
Adobe Acrobat file (No scoring method is available on our website)


Sensitivity And Specificity Of Outcome Measures In Patients With Neck Pain:
Detecting Clinically Significant Improvement

Spine (Phila Pa 1976). 2004 (Nov 1);   29 (21):   2410-2417

The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients' Global Impression of Change (11-point Numerical Rating Scale: 0 = much better, 5 = no change, and 10 = much worse) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Questionnaire. For the total score of the Bournemouth Questionnaire, raw change scores of 13 or more points, percentage change scores of 36% or more, and individual effect sizes of 1.0 or more were all associated with clinically significant improvement. The sensitivity of the Bournemouth Questionnaire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index.


The Bournemouth Questionnaire: A Short-form Comprehensive Outcome Measure.
II. Psychometric Properties in Neck Pain Patients

J Manipulative Physiol Ther 2002 (Mar);   25 (3):   141-148

The neck BQ covers the salient dimensions of the biopsychosocial model of pain, is quick and easy to complete, and has been shown to be reliable, valid, and responsive to clinically significant change in patients with nonspecific neck pain. Its use as an outcome measure in clinical trials and outcomes research is recommended.
 
   

   The Quadruple Visual Analogue Scale   


The Quadruple Visual Analogue Scale
This Adobe Acrobat file covers 4 characteristics of the Patient Complaint: Present Pain, Typical or Average Pain, and Pain Range at it's least and worst.


Responsiveness of Visual Analogue Scale and McGill Pain Scale Measures
J Manipulative Physiol Ther 2001 (Oct);   24 (8):   501–504

The results of this study suggest that the VAS may be a better tool than the McGill Pain Questionnaire for measuring pain in clinical trials and clinical practice.

 
   

   The McGill Pain Questionnaire   


McGill Pain Questionnaire (20 Question Version) ~   in Adobe Acrobat Format
No scoring method is available on our website


McGill Pain Questionnaire (Short Form) ~   in Adobe Acrobat Format
No scoring method is available on our website


The McGill Pain Questionnaire: Major Properties and Scoring Methods
Pain 1975 (Sep);   1 (3):   277-299

The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically.


The Short-form McGill Pain Questionnaire
Pain 1987 (Aug);   30 (2):   191-197

A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors.

 
   

   The Copenhagen Neck Disability Scale   


Copenhagen Neck Disability Scale
Adobe Acrobat version.   No scoring method is available on our website


The Copenhagen Neck Functional Disability Scale:
A Study of Reliability and Validity

J Manipulative Physiol Ther 1998 (Oct);   21 (8):   520–527

The disability scale demonstrated excellent practicality and reliability. The scale accurately reflects patient perceptions regarding functional status and pain as well as doctor's global assessment and is responsive to change over long periods of time. We feel that this scale can be a valuable tool for the assessment of patients in future clinical trials and quality of care studies.

 
   

   The Roland–Morris Questionnaire   


Roland–Morris ~ in Word  or as Adobe Acrobat
The Roland-Morris instrument was developed as an abbreviated SIP (sickness index profile) and is specific for low back pain, like the Revised Oswestry Disability Index. This questionnaire of 24 items can be administered in five minutes and has been validated in randomized trials of spinal manipulation. It was shown to be at least as reliable as the full SIP in cases of acute low back pain. It was found to be slightly more responsive to changes over time than the complete SIP. Compared to the Revised Oswestry Disability Index, the Roland-Morris instrument is also slightly more responsive to changes in acute to subacute low back pain. Thanks to the Illinois Chiropractic Society for putting this Adobe PDF file on line!

How to score the Roland–Morris Questionnaire
A simple, step-by-step analysis, courtesy of the Illinois Chiropractic Society.


The Roland–Morris Questionnaire
There is an abbreviated 18 question low back QA here in this article by Craig Liebenson...check it out!


A Cross-sectional Study Comparing the Oswestry and Roland-Morris
Functional Disability scales in Two Populations of Patients
with Low Back Pain of Different Levels of Severity

Spine 1997 (Jan 1);   22 (1):   68-71

Patients diagnosed with low back pain who exhibited signs of radiculopathy on electromyography had a mean score of 49.1 +/- 17.1 on the Oswestry disability questionnaire; a mean score of 33.0 +/- 14.7 was found for patients who experienced "simple" low back sprain (with no radiculopathy). This difference was statistically significant (P < 0.0001). On the Roland-Morris questionnaire, the mean score obtained by the group of patients with radiculopathy was 59.1 +/- 21.8 compared with 45.4 +/- 19.4 for those with no radiculopathy. This difference was also statistically significant (P < 0.0001). Moreover, there exists a moderate correlation between both functional scales within each group of patients: 0.72 (P < 0.0001) in the group with radiculopathy and 0.66 (P < 0.0001) among those without radiculopathy.

 
   

   Measure Yourself Medical Outcome Profile (MYMOP)   


Measure Yourself Medical Outcome Profile Questionnaire
This is the Initial Form. The Follup-up Form is also available.


Measure Yourself Medical Outcome Profile Scoring Methodology


Use of the Measure Your Medical Outcome Profile (MYMOP2) and W-BQ12
(Well-Being) Outcomes Measures to Evaluate Chiropractic Treatment:
An Observational Study

Chiropr Man Therap. 2011 (Mar 20);   19 (1):   7 [Epub ahead of print] ~ FULL TEXT

This study assesses the use of the MYMOP2 and W-BQ12 questionnaires as outcome measures to monitor changes following chiropractic therapy. Within the limitations of this study, it was shown that both questionnaires were responsive to change. The MYMOP2 also correlated well with the W-BQ12 questionnaire. It thus appears to be a useful instrument for assessing change among chiropractic patients and in the assessment of patient perceived wellbeing for chiropractic patients who present with a variety of symptoms and clinical conditions.

 
   

   Functional Rating Index   


Functional Rating Index
You may request a complimentary copy of the FRI scoring protocols from the Institute of Evidence-Based Chiropractic (owners).


Functional Rating Index: Literature Review
Med Sci Monit. 2010 (Feb);   16:   RA25-36

In 1999, a new self-report outcome measure, the Functional Rating Index (FRI), was developed and tested. This measure demonstrated reasonable reliability, validity and responsiveness. Since the publication of the original testing, numerous independent research teams have examined the psychometric qualities of the FRI and published their findings. The aim of this study is to review the psychometric properties of the FRI as reported by published studies.


Functional Rating Index: A New Valid and Reliable Instrument to Measure
the Magnitude of Clinical Change in Spinal Conditions

Spine (Phila Pa 1976). 2001 (Jan 1);   26 (1):   78-86

The Functional Rating Index appears to be psychometrically sound with regard to reliability, validity, and responsiveness and is clearly superior to other instruments with regard to clinical utility. The Functional Rating Index is a promising useful instrument in the assessment of spinal conditions.

 
   

   The Patient-Specific Functional Scale   


The Patient-Specific Functional Scale
In a recent study, the Patient Specific Functional Scale was the most responsive disability measure in a trail comparing a variety of OA tools. Adobe Acrobat version.   No scoring method is available on our website


Responsiveness of Pain and Disability Measures for Chronic Whiplash
SPINE (Phila Pa 1976) 2007 (Mar 1);   32 (5):   580-585

Pain (pain intensity, bothersomeness, and SF-36 bodily pain score) and disability (Patient Specific Functional Scale, Neck Disability Index, Functional Rating Index, Copenhagen Scale, and SF-36 physical summary) measures were completed by 132 patients with chronic whiplash at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Internal responsiveness was evaluated by calculating effect sizes and standardized response means, and external responsiveness by correlating change scores with global perceived effect scores and by ROC curves. The ranking of responsiveness was consistent across the different analyses. Pain bothersomeness was more responsive than pain intensity, which was more responsive than the SF-36 pain measure. The Patient Specific Functional Scale was the most responsive disability measure, followed by the spine-specific measures, with the SF-36 physical summary measure the least responsive.

 
   

   The Headache Disability Inventory   


Headache Disability Inventory ~   Adobe Acrobat version
Self-completed disability scale measuring the impact of headache on a patients ability to function normally in daily life. It contains 25 items and measures change over time. The responses of *yes*, *sometimes* or *no* are scored 4, 2 and 0 respectively. It is simple to administer and interpret.


The Henry Ford Hospital Headache Disability Inventory (HDI)
Neurology. 1994 (May);   44 (5):   837-842

To quantify the impact of headache of daily living, we developed a 25-item headache disability inventory (HDI). The alpha version of the HDI (alpha-HDI) consisted of 40 items, each requiring a "yes" (four points), "sometimes" (two points), or "no" (zero points) response based on items derived empirically from case history responses of subjects with headache. From the alpha-HDI, we derived a 25-item beta version (beta-HDI) with the items subgrouped into functional and emotional subscales. The internal consistency/reliability was strong, as was construct validity. The test-retest reliability for the beta-HDI was acceptable for the total score and functional and emotional subscale scores.


Headache Disability Inventory (HDI):
Short-term Test-retest Reliability and Spouse Perceptions

Headache. 1995 (Oct);   35 (9):   534-539

We have reported previously that the 25-item Headache Disability Inventory has good internal consistency reliability, robust long-term (2 month) test-retest stability, and good construct validity. We conducted further investigations to evaluate the short-term (1 week) test-retest reliability and spouse perceptions of patients' self-perceived headache disability. The short-term test-retest reliability of the Headache Disability Inventory was excellent. Additionally, the spouse and patients' perceptions of the patient's headache disability generally were congruent, although we observed instances where the differences were marked.

 
   

Psychosocial Outcome Questionnaires
 
   

   The Questionnaire for Assessing Psychosocial Yellow Flags   


Questionnaire for Assessing Psychosocial Yellow Flags
This is the QA designed by Linton & Hallden 1996.

Return to:    The Outcomes Documentation Section

 
   

   Fear Avoidance Beliefs Questionnaire   


Fear Avoidance Beliefs Questionnaire
University of Pittsburgh's Electronic Theses and Dissertations Project Page

The Fear Avoidance Beliefs Questionnaire (FABQ) was developed to study the relationship between LBP, fear avoidance beliefs and behaviors, and chronic disability. This self-report instrument consists of 16 items, each item answered on a 7 point Likert agreement scale that yields two subscales: work and physical activity. High levels of test-retest reliability have been reported for the work subscale (ICC = .90) and physical activity subscale (ICC = .77).


The Predictive Effect of Fear-avoidance Beliefs on Low Back Pain Among Newly Qualified Health Care Workers With and Without Previous Low Back Pain: A Prospective Cohort Study
BMC Musculoskelet Disord. 2009 (Sep 24);   10:   117 ~ FULL TEXT

Health care workers have a high prevalence of low back pain (LBP). Although physical exposures in the working environment are linked to an increased risk of LBP, it has been suggested that individual coping strategies, for example fear-avoidance beliefs, could also be important in the development and maintenance of LBP. Accordingly, the main objective of this study was to examine (1) the association between physical work load and LBP, (2) the predictive effect of fear-avoidance beliefs on the development of LBP, and (3) the moderating effect of fear-avoidance beliefs on the association between physical work load and LBP among cases with and without previous LBP.

 
   

   The Tampa Scale of Kinesiophobia   


Tampa Scale of Kinesiophobia
The Tampa Scale of Kinesiophobia (TSK) that was developed in 1990 is a 17 item scale originally developed to measure the fear of movement related to chronic lower back pain.


The Tampa Scale of Kinesiophobia and Neck Pain, Disability
and Range of Motion: A Narrative Review of the Literature

J Can Chiropr Assoc. 2011 (Sep);   55 (3):   222-232 ~ FULL TEXT

The fear avoidance model can be applied to neck pain sufferers and there is value from a psychometric perspective in using the TSK to assess kinesiophobia. Future research should investigate if, and to what extent, other measureable factors commonly associated with neck pain, such as decreased range of motion, correlate with kinesiophobia.


Norming of the Tampa Scale for Kinesiophobia
Across Pain Diagnoses and Various Countries

Pain. 2011 (May);   152 (5):   1090-1095

The present study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), a frequently used measure of fear of movement/(re)injury. Norms were assessed for the TSK total score as well as for scores on the previously proposed TSK activity avoidance and TSK somatic focus scales. Data from Dutch, Canadian, and Swedish pain samples were used (N=3082). Norms were established using multiple regression to obtain more valid and reliable norms than can be obtained by subgroup analyses based on age or gender.

 
   

Articles about Outcome Questionnaires
 
   

The Outcome Assessment Guidelines Page
These National Guidelines come from a variety of sources.


The Outcome Assessment Book Shelf
Please browse our Outcome Assessment book shelf.   Any books you purchase will help to support our non-commercial website.


Outcome Assessment Reference Articles, Compiled by Category
This collection of primary citations covers Questionnaires, Measuring Instruments, and other assessment methods.


Outcome Measures
This helpful page is by the Victorian WorkCover Authority reviews Outcome basics.


Outcome Assessment in Routine Clinical Practice in Psychosocial Services
British Psychological Society’s Centre for Outcomes, Research and Effectiveness

It is fundamental to the relationship between a user of a service and a clinician that the user should derive some benefit from that relationship. But how can it be determined whether benefit has occurred and how might one go about trying to define or measure such benefits? These are key challenges facing psychosocial services that want to develop systems for the routine monitoring of outcomes.


A Critical Piece of Quality Documentation: Outcomes Assessment
American Chiropractor 2011 (May):   33 (5):   28–34 ~ FULL TEXT

Outcomes assessment tool availability is not a new concept. Back in the 1970’s, long, impractical outcomes tools surfaced that were too cumbersome for routine use in a primary care setting, but shortly thereafter, in 1980, Fairbank introduced the Oswestry (Low Back) Disability Index (ODI). An interesting point is that the original purpose of the ODI was to identify patients that may require “…positive intervention” in the form of psychological care when scores exceeded 60% (defined as “crippled”).


Implementation of Outcome Measures in a Complementary and Alternative
Medicine Clinic: Evidence of Decreased Pain and Improved Quality of Life

J Altern Complement Med 2004 (Jul);   10 (3):   506–513

This study established that a practical data collection system could be implemented in a CAM clinic utilizing several treatment modalities. In addition, outcome measures demonstrated both a significant reduction in pain and improvement in quality of life for subjects who utilized acupuncture, chiropractic, or naturopathy treatments.


The Possibility to Use Simple Validated Questionnaires to Predict
Long-term Health Problems After Whiplash Injury

Spine 2004 (Feb 1);   29 (3):   E47–51

The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.


Assessing the Clinical Significance of Change Scores
Recorded on Subjective Outcome Measures

J Manipulative Physiol Ther 2004 (Jan);   27 (1):   26–35

To date, clinical trials have relied almost exclusively on the statistical significance of changes in scores from outcome measures in interpreting the effectiveness of treatment interventions. It is becoming increasingly important, however, to determine the clinical rather than statistical significance of these change scores.


Subjective and Objective Numerical Outcome Measure Assessment (SONOMA).
A Combined Outcome Measure Tool: Findings on a Study of Reliability

J Manipulative Physiol Ther 2003 (Oct);   26 (8):   481–492

Function-based evaluation and treatment is the wave of the future for physical medicine and particularly for chiropractic for several reasons. First, function is quantifiable. Quantification of the patient-clinical picture promotes better evaluation. This leads to better application of diagnostic procedures and more specifically tailored treatment protocol. Quantification of function also allows us to more appropriately, adequately, and clearly communicate the patient-clinical picture to ourselves, to our patients, and to third parties.


The Relationship of Disability (Oswestry) and Pain Drawings
to Functional Testing

European Spine Journal 2000;   9 (3):   208-212 ~ FULL TEXT

The results of this study indicate that isokinetic test values are significantly influenced by a patient's self-reported disability and pain expression, which can be evaluated using simple tools such as pain drawings and the Oswestry questionnaire. This study supports the supposition that dynamometry testing is related to factors other than muscle performance.


Behavioral Responses to Examination:
A Reappraisal of the Interpretation of "Nonorganic Signs"

SPINE (Phila Pa 1976) 1998 (Nov 1):   23 (21);   2367-2371

Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medico-legally.


Applying Outcomes Management into Clinical Practice
J. Neuromusculoskel. System 1997 (Summer) ;  5 (2):  1-14 ~ FULL TEXT

The paradigm shift in health care from case management to cost contained, outcomes management (OM) has vaulted the study and use of valid and reliable outcomes tools . OM, when used appropriately, can measure progress, or the lack thereof, in three critical areas which include pain management, physical capacity (impairment), and disability.


Quantitative Functional Capacity Evaluation:
The Missing Link to Outcomes Assessment

Topics in Clinical Chiropractic 1996;   3(1):   32-43 ~ FULL TEXT

In the quest of containing health care costs and still offering optimum care in terms of quality, the concepts of outcomes assessment of both subjective and objective varieties are discussed. Discussion of five criteria for the development of an instrument, and a discussion regarding high verses low tech functional testing, and utilization parameters with risk factors for chronicity are discussed.


Measuring Functional Health Status in the Chiropractic Office
Using Self-Report Questionnaires

Topics in Clinical Chiropractic 1994:   1 (1):   51-59 ~ FULL TEXT

The QA is located on page 81-83.
Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of impending change toward more closely managed health care purchasing, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economic and efficient way of accomplishing the task. Two such instruments are presented in detail: the Dartmouth COOP charts and the RAND 36-Item Health Survey 1.0, the latter of which is included in its entirety for use in the office setting. Several other instruments are briefly summarized.


The Neck Disability Index: A Study of Reliability and Validity
J Manipulative Physiol Ther 1991 (Sep);   14 (7):   409–415

Injuries to the cervical spine, especially those involving the soft tissues, represent a significant source of chronic disability. Methods of assessment for such disability, especially those targeted at activities of daily living which are most affected by neck pain, are few in number. A modification of the Oswestry Low Back Pain Index was conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI).While the sample size of some of the analyses is somewhat small, this study demonstrated that the NDI achieved a high degree of reliability and internal consistency.


Proving the Existence of Chronic Pain
Steven G. Yeomans, D.C. ~ FULL TEXT

Pain is ultimately a subjective experience. Proving the existence of pain is therefore, not possible. In practice, when a patient reports pain, the patient is believed to have pain. Yet, not all pain is the same. There may be a variety of reasons for reporting pain to a physician---pain, drug seeking, psychological problems, litigation needs---but there is always a reason. The critical issue is how to untangle the other factors from pain, recognizing that these factors may drive pain and pain may drive these factors.


Outcomes Assessment: How to Satisfy the Insurance Industry
With Time–Efficient Documentation

Craig Liebenson, D.C. and Steven G. Yeomans, D.C. ~ FULL TEXT

This article outlines a simple method for documenting the "medical nesessity" and outcomes of care. At one time or another, we have all found that the reimbursement of a patient's care was being denied. "Please provide documentation to demonstrate the necessity of your treatment" requests are now the norm for the practicing chiropractor. Every provider of every discipline is being held accountable for the care provided to a patient. Why? Because evidence–based treatment approaches are becoming an expected "standard" of proving the effectiveness of care over time, and because tracking outcomes is a means by which insurers decide if the care provided has been necessary.


The SCL–90–R in Clinical Application
The SCL-90-R is a 90-item self-report system inventory developed in the 1980s by Derogatis and designed to reflect the psychological symptom patterns of community, medical and psychiatric respondents. In the special application of CAD trauma and its aftermath, the SCL-90-R is particularly useful. It can validate or challenge the veracity of the patient's claims; it can be used to follow the patient's progress; and it can also be used as an outcome variable in clinical research.


Outcomes: The Key to the Future
Outcomes measurement will be a critical factor if the profession is to establish itself in the managed care market. This was echoed in a recent article in Topics, Clinical Chiropractic titled "Chiropractic Health Care: The Second Century Begins": " ... chiropractic will be pushed by insurers, employers, workers' compensation programs, and managed care plans to demonstrate successful clinical outcomes using cost-efficient care methods."


Spinal Algometry in Clinical Practice
One drawback with palpation is that the examiner is unable to determine how much pressure is being applied. Terms like "mild," "moderate," or "strong" mean different things to different practicioners and patients. An instrument which is very useful in quantifying pressure is the algometer, also known as the pain threshold meter. This is a hand-held force gauge, fitted with a stylus and covered by a 1cm2 rubber tip. An analogue gauge is calibrated in kilograms/cm2, with a minimum reading of 1kg/cm2, and a maximum reading of 10kgs/cm2.

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