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A Low-Back Rating Scale

LEHMANN, THOMAS R., MD; BRAND, RICHARD A., MD; GORMAN, THOMAS W. O., MS

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Clinical research in patients with low-back pain is impeded because there is no quantitative measure of dysfunction. Such a measure would be useful as a control for the condition's severity in subjects to be admitted to clinical trials, as well as a pre- and post-treatment measure to evaluate success. The purpose of this report is to present our approach to developing a scale to measure low back dysfunction. The 105-point rating scale consists of eight parameters grouped into three major parts: (1) physical measurement of trunk strength and range of motion (40 points); (2) patient's perception of pain and dysfunction assessed by an activities questionnaire and a visual analogue pain scale (40 points); (3) physician's perception of dysfunction based on report of pain and medication usage (25 points). The rating scale was tested in 29 patients undergoing lumbar surgery and 48 patients treated in a three-week rehabilitation program. In these rehabilitation patients when both the patient and the physician perceived that the treatment was a success, there was a mean increase of 12.8 points. If both perceived the treatment was unsuccessful there was a mean drop of 1.4 points. The difference between these two subgroups is statistically significant (P = .011). To improve on the rating scale's discriminatory ability, principal component analysis was performed. This analysis predicts that reweighting the eight parameters of the rating scale will improve its performance. Utilizing a scale or index to determine treatment outcome in clinical trials should help to accurately discriminate between effective and ineffective treatment modalities.

Rehabilitation Engineering Center, Department of Orthopaedic Surgery, The University of Iowa, Iowa City, Iowa 52242.

© Lippincott-Raven Publishers.