DOI: 10.1097/01.BRS.0000062001.31152.E8

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Issn Print: 0362-2436

Publication Date: 2003/05/15


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Point of View

Jon D. Lurie

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Excerpt

Currently, a wide variety of health status questionnaires are available to clinicians and researchers. Head-to-head comparisons of differences in health status measures, such as this study by Turner and colleagues, are critical for clinicians and researchers trying to understand which measures to use in different settings. This work adds to the evidence showing the reasonable consistency and validity of the Roland–Morris Disability Questionnaire (RDQ), the Short-Form 36 (SF-36), and the Short-Form 12 (SF-12) in patients with low back problems. The relative responsiveness of these scales is the more interesting and the more complicated question. Because no “gold standard” for better functional health exists, our evaluation of the responsiveness of health status measures will continue to be plagued with the question, “responsive to what?”
The data in Table 5 of this study show that although the RDQ showed more improvement in the group overall at follow-up assessment (responsiveness to “expected” change), and more improvement in the group who rated themselves as improved at follow-up assessment (so-called responsiveness to estimated change), 1 it also showed almost as much improvement in the group who rated themselves as experiencing “no change.” In sharp contrast, the physical scales of both the SF-12 and the SF-36 demonstrated lower functional health status scores in the patients whose rating was “no change.” The number of patients in the “no change” group was small, and we do not have sufficient information to know what the “right” answer is. However, these data certainly raise the question as to whether part of the RDQ’s responsiveness in this study represents spurious improvement or improvement in aspects of functional health that are not important to patients when they consider whether they are better or not.
Another key aspect of this study for readers to keep in mind is that the population studied had very low levels of disability. Whereas the average baseline score on the physical function scale of the SF-36 in this population was 65, the average score in the general population is 85, 2 the average score for patients seen in the National Spine Network was 42, 2 and the average score for workers’ compensation patients in the Maine Lumbar Spine Study was 29. 3 This very low level of disability is likely responsible for the large ceiling effects of the SF-36 seen in this study. Whether the findings of this study would be similar for the more severely impaired patients usually seen by spine practitioners requires further study.

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