Elsevier

Manual Therapy

Volume 14, Issue 3, June 2009, Pages 283-291
Manual Therapy

Original article
The test–retest reliability and concurrent validity of the Subjective Complaints Questionnaire for low back pain

https://doi.org/10.1016/j.math.2008.02.010Get rights and content

Abstract

Physiotherapists commonly record detailed patient information regarding subjective complaints for low back pain (LBP), particularly to assist in the process of classifying patients into specific subgroups. A self-administered Subjective Complaints Questionnaire for LBP (SCQ-LBP) measuring such information was developed for the purposes of future clinical research, particularly in the area of LBP classification.

The development comprised literature review, feedback from experienced physiotherapists and pilot questionnaire testing in a patient population. Test–retest reliability of the questionnaire in a self administered format as well as concurrent validity against a suitable reference standard was evaluated. The agreement between the self administered questionnaire compared to when administered by a physiotherapist was also tested as the latter method is the most common form of retrieving subjective complaints in clinical practice.

Thirty participants with LBP were recruited and at least moderate test–retest reliability was demonstrated in 56 of the 57 self administered questionnaire items. Preliminary evidence was found supporting the concurrent validity of selected items. At least moderate agreement was demonstrated in 51 of the 57 items when comparing between the self administered and physiotherapist administered conditions.

The questionnaire is a useful tool for collecting subjective complaints information, particularly for clinical research on the classification of LBP, however, further research regarding validity is required.

Introduction

Subjective complaints, reported by the sufferer in spoken or written form, are commonly documented as part of the standard assessment of low back pain (LBP). In clinical practice physiotherapists use a detailed subjective complaints interview to retrieve large amounts of information regarding the nature of symptoms, aggravating/easing factors, 24 h symptom behaviour, history and special questions (McKenzie et al., 2003, Maitland, 2005). This subjective complaints information can then be used to classify patients into subgroups that receive specific treatment (Delitto et al., 1995, McKenzie et al., 2003, Maitland, 2005). A common clinical example of using subjective complaints in the classification of LBP is the identification of an inflammatory cause of symptoms using criteria such as constancy of pain and a perception of stiffness in the injured area lasting at least 1 h after waking. Such patients may respond more effectively to anti-inflammatory modalities rather than treatment directed at a mechanical cause of symptoms (McKenzie et al., 2003, Maitland, 2005).

Improved classification of LBP has been described as a high research priority by an esteemed international working group (Borkan and Cherkin, 1996). However, a number of review papers show that published classification systems have yet to demonstrate adequate reliability or validity and that methodological problems are common (Riddle, 1998, Petersen, 1999, Ford et al., 2007). One of the issues in the literature evaluating classification systems for LBP is the use of unreliable or poorly validated measurement tools for collecting data relevant to the classification process (Riddle, 1998, Petersen, 1999, Ford et al., 2007). There is relatively little research into reliable and valid methods of measuring subjective complaints. Only one study has reported on a comprehensive tool for measuring subjective complaints in individuals with LBP. The questionnaire developed included items such as the nature of symptoms, aggravating factors and history and variable test–retest reliability was found for the different questionnaire components (Walsh and Coggon, 1991). A 1-year retest period was used to minimise memory effects, however, a potential adverse consequence of this approach on the results may have been a spontaneous change in the nature and/or severity of the LBP. In addition the details of questionnaire wording and scoring were not described.

The Multi-perspective Multi-dimensional Pain Assessment Protocol has been developed as a self administered questionnaire for chronic pain. It contains items on patient details, nature of symptoms, aggravating and easing factors, 24 h behaviour and history (Rucker et al., 1996). The questionnaire was developed with a view to maximising content validity and on evaluation, acceptable reliability and validity were demonstrated. However, the items in the questionnaire were not sufficiently comprehensive or specific to be used for the assessment of LBP patients when compared to accepted methods currently in widespread clinical use by physiotherapists (McKenzie et al., 2003, Maitland, 2005).

A number of recent papers have evaluated the reliability of a variety of classification systems, however, typically subjective complaints are either poorly defined or insufficiently comprehensive to reflect the clinical practice of physiotherapists (Heiss et al., 2004, Petersen et al., 2004, Bertilson et al., 2006, Dankaerts et al., 2006, Fritz et al., 2006). One paper has been published investigating the reliability of the McKenzie classification system using a specific assessment form that included subjective complaints information (Clare et al., 2005). However, the ability of the form itself to reliably retrieve information from patients on retesting was not evaluated.

On the basis of this insufficient literature, there are limited options for clinical researchers wishing to use a reliable and valid questionnaire that comprehensively assesses subjective complaints for LBP. The aims of this study were therefore to develop a questionnaire for the self administered measurement of subjective complaints in LBP, and to evaluate its test–retest reliability and concurrent validity. Self administered questionnaires are an efficient method of data collection in clinical research. The purpose of this study was not to investigate the value of a particular classification system for LBP, but rather to establish a reliable and valid tool for the measurement of subjective complaints for use in future clinical research, particularly in the area of classification.

Section snippets

Questionnaire development

The critical components of our Subjective Complaints Questionnaire for low back pain (SCQ-LBP) comprised nature of symptoms, aggravating and easing factors, 24 h behaviour, and history. These components were predetermined based on clinical approaches commonly used by physiotherapists (McKenzie et al., 2003, Maitland, 2005). The specific questionnaire items were developed in four stages: literature review, operational definition of questionnaire items, peer review of the questionnaire, and pilot

Results

Thirty participants provided informed consent and completed the data collection. There were no withdrawals from the study. The demographic and clinical characteristics of the sample are presented in Table 1.

A one-way repeated measures analysis of variance found no significant within participant difference in the Quebec Back Pain Disability Scale scores across the measurement sessions (df = 3.26, F = 0.42, p = 0.66). This indicates that spontaneous change over time had no significant effect on

Discussion

The SCQ-LBP was developed using the methodology of literature review, review from a panel of experienced physiotherapists, and pilot testing on a sample of individuals with LBP. The test–retest reliability of the developed questionnaire was acceptable. Specifically, at least moderate agreement was found on 56 of the total 57 items on test–retest of the SCQ-LBP in the SA.

The concurrent validity of the SCQ-LBP was examined by a comparison of the SA to the PO. In the PO each participant was tested

Conclusion

The SCQ-LBP was developed for the purpose of providing a measurement tool for subjective complaints in the classification of LBP. The test–retest reliability of the self administered SCQ-LBP was established as well as preliminary evidence for the concurrent validity of selected items compared with an acceptable reference standard. Moderate agreement between the SA with the PA demonstrate that subjective complaints information can be measured with similar levels of agreement using a self

References (36)

  • W. Boissonnault et al.

    Pain profile of patients with low back pain referred to physical therapy

    Journal of Orthopedic and Sports Physical Therapy

    (1996)
  • J. Borkan et al.

    An agenda for primary care research on low back pain

    Spine

    (1996)
  • A. Burdorf et al.

    Comparison of methods for the assessment of postural load on the back

    Scandinavian Journal of Work and Environmental Health

    (1991)
  • E.G. Dawson et al.

    Low back pain recollection versus concurrent accounts: outcomes analysis

    Spine

    (2002)
  • A. Delitto et al.

    A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment

    Physical Therapy

    (1995)
  • J. Ford et al.

    Classification systems for low back pain: a review of the methodology for development and validation

    Physical Therapy Reviews

    (2007)
  • J.M. Fritz et al.

    An examination of the reliability of a classification algorithm for subgrouping patients with low back pain

    Spine

    (2006)
  • D.G. Heiss et al.

    The interrater reliability among physical therapists newly trained in a classification system for acute low back pain

    Journal of Orthopedic and Sports Physical Therapy

    (2004)
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