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How little pain and disability do patients with low back pain have to experience to feel that they have recovered?

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Abstract

Epidemiological and clinical studies of people with low back pain (LBP) commonly measure the incidence of recovery. The pain numerical rating scale (NRS), scores from 0 to 10, and Roland Morris disability questionnaire (RMDQ), scores from 0 to 24, are two instruments often used to define recovery. On both scales higher scores indicate greater severity. There is no consensus, however, on the cutoff scores on these scales that classify people as having recovered. The aim of this study was to determine which cutoff scores most accurately classify those who had recovered from LBP. Subjects from four clinical studies were categorized as ‘recovered’ or ‘unrecovered’ according to their self-rating on a global perceived effect scale. Odd ratios were calculated for scores of 0, 1, 2, 3 and 4 on the NRS and RMDQ to predict perceived recovery. Scores of 0 on the NRS and ≤2 on the RMDQ most accurately identify patients who consider themselves completely recovered. The diagnostic odds ratio (OR) for predicting recovery was 43.9 for a score of 0 on the NRS and 17.6 for a score of ≤2 on the RMDQ. There was no apparent effect of LBP duration or length of follow-up period on the optimal cutoff score. OR for the NRS were generally higher than those for RMDQ. Cutoffs of 0 on the NRS and 2 on the RMDQ most accurately classify subjects as recovered from LBP. Subjects consider pain more than disability when determining their recovery status.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia

    Steven J. Kamper, Christopher G. Maher & Robert D. Herbert

  2. Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia

    Mark J. Hancock & Julia M. Hush

  3. Rehabilitation Foundation Limburg, Department of Rehabilitation Medicine, Caphri, Maastricht University, Maastricht, The Netherlands

    Robert J. Smeets

Authors
  1. Steven J. Kamper
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  2. Christopher G. Maher
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  3. Robert D. Herbert
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  4. Mark J. Hancock
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  5. Julia M. Hush
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  6. Robert J. Smeets
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Corresponding author

Correspondence to Steven J. Kamper.

Appendix

Appendix

Global perceived effect scale

Compared to when this episode first started, how would you describe your back these days?

figure a

Pain numerical rating scale

I would like you to rate your pain on a scale from 0 to 10 where 0 is no pain and 10 is the worst pain possible. Please give a number to describe your pain at the present time.

figure b

Roland Morris disability questionnaire

When your back hurts, you may find it difficult to do some of the things you normally do.

This list contains some sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because they describe you today. As you read the list, think of yourself today. When you read a sentence that describes you today, fill the box to the left of the sentence. If the sentence does not describe you, then leave the box blank and go onto the next one. Remember, only mark the sentence if you are sure that it describes you today.

figure c

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Kamper, S.J., Maher, C.G., Herbert, R.D. et al. How little pain and disability do patients with low back pain have to experience to feel that they have recovered?. Eur Spine J 19, 1495–1501 (2010). https://doi.org/10.1007/s00586-010-1366-1

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  • DOI: https://doi.org/10.1007/s00586-010-1366-1

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