Conceptual Foundations of Occupational Therapy

Study design Cross-sectional study of 63 patients with chronic low back pain (CLBP). Objectives To determine the relationship between the SF-36 physical functioning (PF) scale and physical performance on a modified symptom limited treadmill test, and to determine the effect of disability status and SF-36 mental health (MH) scores on self-reported physical functioning and on physical performance. Summary of background data Patients with CLBP report low levels of physical functioning. Because self-report measures are influenced by psychosocial factors, such as disability and low MH, a common recommendation is to supplement self-report with objective or physical performance testing. Little information exists regarding whether performance testing is also influenced by disability and low MH. Materials and methods Patients completed the SF-36 and performed a maximal, symptom-limited, modified treadmill test. Total walking time and heart rate on the treadmill were registered. The effects of disability and low MH on self-report and performance testing were calculated by unpaired Student's t-testing and effect size estimation. Results A strong relationship between the PF scale of the SF-36 and treadmill walking time was found, but there was little evidence of overlap between these physical functioning domains. Both disability status and low MH had a much larger effect on self-report measures than on physical performance. Conclusions Self-report measurements and performance-based assessments provide information about distinct, although related, domains of physical functioning. Disability and low MH are associated with lower SF-36 PF scores. Our results confirm that self-report measures require supplementation with objective performance testing to provide optimal assessment for patients with CLBP.

Physical functioning: self-report and performance measures are related but distinct.

Handbook of behavioral medicine

This paper will help clinicians and researchers to understand studies on the validity, responsiveness and reliability of patient-reported outcome measures (PROMs) and to interpret the scores and change scores derived from these and other types of outcome measures. Validity studies provide a method for assessing whether the underlying construct of interest is adequately assessed. Responsiveness studies explore the longitudinal validity of a test and provide evidence that an instrument can detect change in the construct of interest. Reliability is commonly assessed with correlation indices, which indicate the stability of repeated measurements and the 'noise' or error in the measurement. Proposed indicators for clinical interpretation of test scores are the minimum clinically important difference, the standard error of measurement and the minimum detectable change. Studies of the Victorian Institute of Sports Assessment questionnaire for patellar tendinopathy and other PROMs are used to illustrate concepts.

https://bjsm.bmj.com/content/bjsports/48/9/792.full.pdf

Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? A practical guide for clinicians and researchers who are not biostatisticians

With the present review of literature, the authors intended to compare the definition terms, selection criteria, and measurement tools or methods used in different studies related to chronic low back pain (CLBP) patients. The relevance of including all the above information is that any health-care professional can use them to evaluate their treatment methods with CLBP patients or use them in study designs according to their objectives. These measurements concern pain measurements, measures that were used to describe the CLBP pain, questionnaires used to measure the CLBP patients' responses to pain, the pain effects on their living activities, and also measurements of the physical abilities and functional performance. A computerized literature search in English MEDLINE was conducted using "low back pain," and "flexibility, "strength,""evaluation,""functional level," and "measurements" as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Interms of CLBP definitions, the authors concluded that is best defined as a lumbar, sacral, or lumbosacral spinal pain that is continuous or essentially continuous but low level punctuated by exacerbations of pain, each of which is characterized as "acute." In order to establish the criteria for selecting participants in a study design related to CLBP, pain characteristics and clinical diagnoses have to be taken into consideration for obtaining homogeneity of groups. Finally, the selection of measurement tools and evaluation methods is related to the study's goals, the specialization of the researchers, and their validity.

Measurements and evaluations in low back pain patients.

This study examined the relationship between perceived (stated) levels of function and the measured (observed) performance in squatting and stair climbing activities of 20 patients with chronic low back pain (CLBP) and 20 healthy volunteers. Subjects were asked through an interview to self-assess their ability to comfortably perform stair climbing and squatting as well as other tolerances. The subjects were then asked to perform the activities and their performance levels were recorded. Results revealed that patients' estimate of squatting and stair climbing abilities as well as their demonstrated levels were significantly lower (p < 0.001) than those of the healthy subjects. There was a significant difference between groups in terms of the time required to perform squatting but not stair climbing. Both groups underestimated their physical capabilities. Findings indicate that the use of actual performance measurement combined with self-report of functional abilities is needed when assessing performance le...

/pdf/stated-versus-observed-performance-levels-in-patients-with-396ribznsz.pdf

Alma R. Abdel-Moty

Papers

Stated versus Observed Performance Levels in Patients with Chronic Low Back Pain.