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Chiropractic Research Review

Are Condition-Specific Surveys Necessary?

Surveys of self-reported health, including the Oswestry Disability Index and the SF-36, are frequently used to assess patient outcomes. However, the responsiveness of these surveys to changes in patient condition has not been fully compared, despite their common usage.

Although condition-specific surveys are generally considered more responsive to changes in status than general health surveys for low-back pain, adequate research does not support this hypothesis.

Using an analysis of data gathered from patients in 27 National Spine Network member centers, this study evaluated the responsiveness of MODEMS (Musculoskeletal Outcomes Data Evaluation and Management System) scales, the Oswestry Index and SF-36 scales for patients presenting with low-back pain with leg symptoms. Each of these forms includes at least one pain scale, as well as other questions. The MODEMS and Oswestry measure the degree of functional limitation imposed upon a patient by low-back pain; the SF-36 assesses the patient's overall health status. The authors analyzed surveys of patients with herniated discs, spondylosis or spinal stenosis, completed initially and three months after treatment. Most patients utilized multiple forms of treatment, including surgery (27%) and chiropractic care (18%).

Complete data from both survey periods were available for 970 patients. Pain scales showed significantly greater responsiveness than scales assessing function. No significant differences in responsiveness were noted between pain scales imbedded within the SF-36 and those of the MODEMS or Oswestry scales.

Conclusion: For studies of low-back pain, the general SF-36 may provide sufficient information on health status and patient function without additional condition-specific scales, which add to data collection and analysis burdens. The authors note, "Generalizing these findings beyond the issue of back pain / leg symptoms is probably unwise."

The purpose of this study was to determine if condition-specific instruments are necessary in low-back-pain research. The findings of this study may not be transferable to the typical clinical environment in which the DC wishes to document both pain and function of individual patients.

Walsh TL, Hanscom B, et al. Is a condition-specific instrument for patients with low back pain / leg symptoms really necessary? Spine 2003:28(6), pp. 607-615.

Chiropractic Research Review

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