Davidson Megan, Keating Jennifer L
School of Physiotherapy, La Trobe University, Bundoora, 3053, Melbourne, Australia.
Phys Ther. 2002 Jan;82(1):8-24. doi: 10.1093/ptj/82.1.8.
The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain.
Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected.
Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other.
Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.
本研究旨在检验5种常用的评估腰痛患者残疾程度的问卷。对接受腰痛物理治疗的患者比较了改良的奥斯维斯特残疾问卷、魁北克腰痛残疾量表、罗兰-莫里斯残疾问卷、瓦德尔残疾指数以及医学结局研究简明健康调查36项量表（SF-36）中的身体健康量表。
腰痛患者在初次与物理治疗师会诊时以及6周后再次填写问卷（n = 106）。对47名被归类为“无变化”的受试者以及16名自评“大致相同”的受试者亚组进行了重测信度检验。使用标准化反应均值、受试者工作特征曲线以及至少改变量达到最小可检测变化（MDC）（重复测量标准误的90%置信区间[CI]）的受试者比例比较反应性。如果不超过15%的受试者初始分数处于量表的上限或下限，以至于无法可靠检测到变化，则判定量表宽度足够。
为测量被归类为“无变化”的受试者以及自评“大致相同”的受试者的信度而计算的组内相关系数（2,1），对于奥斯维斯特问卷、魁北克问卷以及SF-36身体功能量表大于0.80，对于瓦德尔问卷、罗兰-莫里斯问卷以及SF-36角色受限-身体和身体疼痛量表小于0.80。没有一个量表比其他量表反应性更高。
使用改良的奥斯维斯特残疾问卷、SF-36身体功能量表以及魁北克腰痛残疾量表获得的测量结果最可靠，并且具有足够的量表宽度以可靠地检测大多数受试者的改善或恶化情况。使用瓦德尔残疾指数获得的测量结果信度中等，但该量表似乎不足以推荐用于临床应用。罗兰-莫里斯残疾问卷以及SF-36的角色受限-身体和身体疼痛量表似乎缺乏足够的信度和量表宽度用于临床应用。
