Ann R Coll Surg Engl 2008; 90: 497-499 497Low back pain is one of the commonest causes of disability and affects most members of society at some time in their lives. [1][2][3] Several questionnaires are available to help measure the functional status of a patient. [4][5][6][7][8] The Oswestry Disability Index (ODI) 7,9 is the most commonly used outcome-measure questionnaire for low back pain in a hospital setting. It is a self-administered questionnaire divided into ten sections designed to assess limitations of various activities of daily living. Each section is scored on a 0-5 scale, 5 representing the greatest disability. The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage. Thus, for every question not answered, the denominator is reduced by 5. If a patient marks more than one statement in a question, the highest scoring statement is recorded as a true indication of disability. The questionnaire takes 3.5-5 min to complete and approximately 1 min to score. 7 The aim of this study was to see if training in completing the ODI forms improved the scoring accuracy.
Patients and MethodsOne hundred consecutive ODI forms were reviewed retrospectively and errors in scoring recorded. The correct method of scoring was explained to the staff and further training provided. A chart with all possible scores was also developed as a scoring aid (Fig. 1). Laminated posters of the chart were displayed in the out-patient clinics. A smaller, pocket version of the scoring chart was also provided to the staff.Following this education process, a prospective audit was conducted on 50 consecutive questionnaires that had one or more unmarked sections.
ResultsThis retrospective study showed 33 out of 100 forms were incorrectly scored. In two forms, all 10 sections were completed but the scores had been added up incorrectly. The remaining 31 questionnaires had one or more unmarked sections that had been considered not applicable
Volumetric asymmetry correlates better with both mental health and self-image compared with Cobb angle, but the correlation was only moderate. This study suggests that a patient's own perception of self-image and mental health is multifactorial and not completely explained through present objective measurements of the size of the deformity. This helps to explain the difficulties in any objective analysis of a problem with multifactorial perception issues. Further study is required to investigate other physical aspects of the deformity that may have a role in how patients view themselves.
The SRS-22 questionnaire is robust and a true reflection of patients' assessment of their symptoms not influenced by meeting a physician. Assessment of the child by the parent is not statistically different from the child's self-assessment using the SRS-22 instrument. It makes no difference to the total SRS-22 score as to when it is measured in the initial clinic visit.
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