From the *National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom; †Nuffield Orthopaedic Centre, Oxford, United Kingdom.
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Condition-specific health status measures are commonly used as outcome measures in clinical trials and to assess patient progress in routine clinical practice. The expert panel that met to discuss this special issue of Spine recommended that, when possible, a condition-specific measure for back pain should be chosen from two widely used measures, the Roland–Morris Disability Questionnaire 106 (RDQ) or the Oswestry Disability Index (ODI). 30 These two measures have been used in a wide variety of situations over many years, and each is available in a number of languages.In this article, the authors describe these two instruments and provide evidence of their validity and reliability and some comparative results obtained with the use of the two questionnaires. The instruments themselves are included in the appendix es. When used in the forms reproduced in the appendix es, no permission is required from the authors or from Spine. Other back pain–specific health status measures are described by Kopec elsewhere in this edition of Spine. 67The Roland–Morris Disability QuestionnaireDevelopmentThe RDQ 106 is a health status measure designed to be completed by patients to assess physical disability due to low back pain. It was designed for use in research (e.g., as an outcome measure for clinical trials) but has also been found useful for monitoring patients in clinical practice. It was originally designed for use in primary care in the United Kingdom but has been used in a variety of other settings.The RDQ was derived from the Sickness Impact Profile (SIP), 3 which is a 136-item health status measure covering all aspects of physical and mental function. Twenty-four items were selected from the SIP by the original authors because they related specifically to physical functions that were likely to be affected by low back pain. Each item was qualified with the phrase “because of my back pain” to distinguish back pain disability from disability due to other causes—a distinction that patients are in general able to make without difficulty. 103Patients completing the RDQ are asked to place a check mark beside a statement if it applies to them that day. This approach was chosen to make it suitable for observing short-term changes in back pain (e.g., the relatively rapid resolution of symptoms of most patients seen in primary care) or short-term changes in response to treatment. The RDQ score is calculated by adding up the number of items checked. Items are not weighted. The scores therefore range from 0 (no disability) to 24 (maximum disability). Although designed for administration on paper, the RDQ has also been satisfactorily administered on computer and by telephone.The original RDQ also contains a 6-point pain rating scale in the form of a pain thermometer. However, the current authors now recommend that the pain scale of the SF-36 be used in preference, as described in the article on pain measurement by Von Korff et al. elsewhere in this issue. 147The RDQ is short, simple to complete, and readily understood by patients. Stratford et al 121 found fewer incomplete or ambiguous responses to the RDQ than to the Oswestry questionnaire. These characteristics, along with evidence of its scientific validity, have led to its widespread use. It is now available in the 12 languages listed in the next section. The questionnaire is reproduced in Appendix 1. As previously stated, there are no restrictions on its use.