Outcome Assessments in the Evaluation of Treatment of Spinal Disorders: Summary and General Recommendations

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Abstract.Clinicians and researchers increasingly recognize the importance of the patient’s perspective in the evaluations of the effectiveness of treatment. The rapid growth in the number and types of patient-based outcome measures can be confusing. This supplement provides a state-of-the-art review of the available tools. In this paper, the key recommendations from the participating authors are summarized. A core set of measures should include the following five domains: back specific function, generic health status, pain, work disability, and patient satisfaction. Two commonly used measures of back-specific function are recommended: the Roland–Morris Disability Questionnaire and the Oswestry Disability Index. Among the generic measures, the SF-36 strikes the best balance between length, reliability, validity, responsiveness, and experience in large populations of patients with back pain. Moreover, the SF-36 Bodily Pain Scale provides a brief measure of pain intensity and pain interference with activities. Health-related work disability should include at a minimum a measure of work status and work-time loss. For those who are still at work, new measures are being developed to measure health-related work limitations. No single measure of patient satisfaction is clearly preferred but guiding principles are provided to choose among available measures. In addition to the five recommended domains, preference-based health outcome measures, including patients utilities, may be useful when there is a need to value alternative health outcomes.

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