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The Orebro Musculoskeletal Screening Questionnaire: Validation of a modified primary care musculoskeletal screening tool in an acute work injured population

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The original Örebro Musculoskeletal Pain Questionnaire (original-ÖMPQ) was developed to identify patients at risk of developing persistent back pain problems and is also advocated for musculoskeletal work injured populations. It is critiqued for its informal non-clinimetric development process and narrow focus. A modified version, the Örebro Musculoskeletal Screening Questionnaire (ÖMSQ), evolved and progressed the original-ÖMPQ to broaden application and improve practicality. This study evaluated and validated the ÖMSQ clinimetric characteristics and predictive ability through a single-stage prospective observational cohort of 143 acute musculoskeletal injured workers from ten Australian physiotherapy clinics. Baseline-ÖMSQ scores were concurrently recorded with functional status and problem severity outcomes, then compared at six months along with absenteeism, costs and recovery time to 80% of pre-injury functional status. The ÖMSQ demonstrated face and content validity with high reliability (ICC(2.1) = 0.978, p < 0.001). The score range was broad (40-174 ÖMSQ-points) with normalised distribution. Factor analysis revealed a six-factor model with internal consistency α = 0.82 (construct range α = 0.26-0.83). Practical characteristics included completion and scoring times (7.5 min), missing responses (5.6%) and Flesch-Kincaid readability (sixth-grade and 70% reading-ease). Predictive ability ÖMSQ-points cut-off scores were: 114 for absenteeism, functional impairment, problem severity and high cost; 83 for no-absenteeism; and 95 for low cost. Baseline-ÖMSQ scores correlated strongly with recovery time to 80% functional status (r = 0.73, p < 0.01). The ÖMSQ was validated prospectively in an acute work-injured musculoskeletal population. The ÖMSQ cut-off scores retain the predictive capacity intent of the original-ÖMPQ and provide clinicians and insurers with identification of patients with potentially high and low risks of unfavourable outcomes.
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Original article
The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied
primary care musculoskeletal screening tool in an acute work injured population
Charles Philip Gabel
a
,
b
,
*
, Markus Melloh
c
, Brendan Burkett
a
, Jason Osborne
d
, Michael Yelland
b
a
Faculty of Science, Centre for Healthy Activities, Sport and Exercise, University of the Sunshine Coast, Sippy Downs, Sunshine Coast, Queensland 4556, Australia
b
Primary Health Care Section, School of Medicine, Grifth University, Queensland, Australia
c
Western Australian Institute for Medical Research (WAIMR), University of Western Australia, Nedlands, Western Australia, Australia
d
Educational Foundations and Leadership, Darden College of Education, Old Dominion University, Norfolk, VA, USA
article info
Article history:
Received 9 January 2012
Received in revised form
24 May 2012
Accepted 29 May 2012
Keywords:
Screening
Absenteeism
Injury
Musculoskeletal
abstract
The original Örebro Musculoskeletal Pain Questionnaire (original-ÖMPQ) was developed to identify
patients at risk of developing persistent back pain problems and is also advocated for musculoskeletal
work injured populations. It is critiqued for its informal non-clinimetric development process and
narrow focus. A modied version, the Örebro Musculoskeletal Screening Questionnaire (ÖMSQ), evolved
and progressed the original-ÖMPQ to broaden application and improve practicality. This study evaluated
and validated the ÖMSQ clinimetric characteristics and predictive ability through a single-stage
prospective observational cohort of 143 acute musculoskeletal injured workers from ten Australian
physiotherapy clinics. Baseline-ÖMSQ scores were concurrently recorded with functional status and
problem severity outcomes, then compared at six months along with absenteeism, costs and recovery
time to 80% of pre-injury functional status. The ÖMSQ demonstrated face and content validity with high
reliability (ICC
2.1
¼0.978, p<0.001). The score range was broad (40e174 ÖMSQ-points) with normalised
distribution. Factor analysis revealed a six-factor model with internal consistency
a
¼0.82 (construct
range
a
¼0.26e0.83). Practical characteristics included completion and scoring times (7.5 min), missing
responses (5.6%) and FlescheKincaid readability (sixth-grade and 70% reading-ease). Predictive ability
ÖMSQ-points cut-off scores were: 114 for absenteeism, functional impairment, problem severity and
high cost; 83 for no-absenteeism; and 95 for low cost. Baseline-ÖMSQ scores correlated strongly with
recovery time to 80% functional status (r¼0.73, p<0.01). The ÖMSQ was validated prospectively in an
acute work-injured musculoskeletal population. The ÖMSQ cut-off scores retain the predictive capacity
intent of the original-ÖMPQ and provide clinicians and insurers with identication of patients with
potentially high and low risks of unfavourable outcomes.
Ó2012 Elsevier Ltd. All rights reserved.
1. Introduction
The early identication of patients at risk of developing
disability from chronic musculoskeletal conditions is essential
(Melloh et al., 2012). Despite the small percentage of injuries that
transition from acute to chronic (Melloh et al., 2011), this subgroup
accounts for the majority of nancial (Driessen et al., 2008), indi-
vidual and societal costs (Ekman et al., 2005). This subgroup is
generally identied through their subjective history and the clini-
ciansexperience and expertise (Bell and Burnett, 2009). However,
the human judgement process can be awed, particularly in
identifying fear-avoidance (Calley et al., 2010), catastrophizing
(Sullivan et al., 2011) and disability (Maher and Grotle, 2009).
Screening questionnaires can supplement this judgement process,
particularly for musculoskeletal conditions (Liebenson and
Yeomans, 2007). The Örebro Musculoskeletal Screening Question-
naire(ÖMSQ)(Gabel et al., 2011) is a recently developed instru-
ment designed for this purpose and is a modied version of the
original Örebro Musculoskeletal Pain Questionnaire (original-
ÖMPQ) (Linton, 1999).
The original-ÖMPQ was developed to identify patients at risk of
persistent pain. It is widely used and adapted from the Acute Low
Back Pain Screening Questionnaire (ALBPSQ) (Linton and Hallden,
1998). It is advocated in clinical guidelines (van Tulder et al.,
2006) and workers compensation guidelines (ACC-New Zealand,
2004;Workers Compensation Authority NSW, 2006;WorkCover
SA, 2007;WorkSafe-TAC Victoria, 2007). Two systematic reviews
of the original-ÖMPQ (Hockings et al., 2008;Sattelmayer et al.,
*Corresponding author. Faculty of Science, Centre for Healthy Activities, Sport
and Exercise, University of the Sunshine Coast, Sippy Downs, Sunshine Coast,
Queensland 4556, Australia. Tel.: þ61 (0)408 48 1125; fax: þ61 5471 7022.
E-mail addresses: cp.gabel@bigpond.com (C.P. Gabel), markus.melloh@
uwa.edu.au (M. Melloh), bburkett@usc.edu.au (B. Burkett), jxosborn@odu.edu
(J. Osborne), m.yelland@grifth.edu.au (M. Yelland).
Contents lists available at SciVerse ScienceDirect
Manual Therapy
journal homepage: www.elsevier.com/math
1356-689X/$ esee front matter Ó2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.math.2012.05.014
Manual Therapy xxx (2012) 1e12
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
2011) raised several critiques. These included the informal non-
clinimetric development process and the use of total cut-off
scores. Additional concerns have included the face and content
validity, and that general musculoskeletal injuries and non-
working individuals are not specically included (Hurley et al.,
2000;Margison and French, 2007). Consequently, to address
these concerns the original-ÖMPQ was modied and progressed
through rigorous clinimetric methodology to broaden its applica-
tion and improve both practicality and suitability, resulting in the
ÖMSQ.
The ÖMSQ incorporated the original-ÖMPQsgeneralised
musculoskeletalapplication and screeningobjectives and
retained the item format, score range, and concept of cut-off score
recommendations (Brown, 2008;Johnston, 2009). Simultaneously,
the ÖMSQ simplied the questions, improved the psychometric
characteristics (factor structure, face and content validity), practical
characteristics (33% reduction in missing responses), and predictive
ability. This revised instrument broadened the focus to general
musculoskeletal problems, rather than the original emphasis on
back,painand work(Gabel et al., 2011). To continue this
development the aims of this study were to: examine the ÖMSQ
format for an acute musculoskeletal work-injured population; and
further develop the clinimetric properties and predictive validity
for the outcomes of function, problem severity, absenteeism,
insurer costs and recovery time at six months.
2. Material and methods
2.1. Study design
A single phase prospective, observational cohort study was
conducted in an independent work-related musculoskeletal injury
population (Fig. 1).
2.2. Patients and setting
An inception cohort (n¼143, 42.6% female, age 38.9 10.5,
range 18e65 years) was formed from consecutive outpatients,
recruited from a convenience sample referred by medical
practitionersto 10 Australian physiotherapy centres. Each referrer
was interviewed where study goals and protocols were discussed.
This facilitated referrals and minimised potential confounding
through non-referral of suitable participants. The affected body
areas included the back (50%), neck (16%), upper limbs (22%) and
lower limbs (12%) with 5% of participants being multi-area injury.
This was proportionally representative of the work-related injury
population in the sampled geographical region (WorkCover
Queensland, 2005). All participants were entitled to wage related
compensation under the governing legislation. Consistency in
entitlement was anticipated to minimise any confounding inu-
ence of nancial compensation on individual recovery. The sample
size required for each subgroup was estimated using the primary
variable of the score and calculated from the original ÖMSQ LBP
validation study (Gabel et al., 2011) with an 80% chance of detecting
difference between baseline and repeated measures (p<0.05) and
allowing an additional 15% attrition. This gave sample estimates for
test-retest reliability of n>42, for predictive validity of n>126,
and for factor analysis of n>120 (Field, 2005).
2.3. Inclusion and exclusion criteria
Participants included in the study had an acute musculoskel-
etal injury to the spine, upper limb or lower limb, sustained at
work within the previous ve weeks (NHMRC, 2003). The date of
injurywas dened as the date the current injury commenced and
included provocation or worsening of a pre-existing injury. This
classication accounted for 20% (n¼29) of participants. Exclusion
criteria were pregnancy, red ags for serious spinal pathology,
difculty with English comprehension and <18 years. No upper
age limit was specied in order to comply with equal opportunity
and discrimination laws and maximise full workforce represen-
tation. The insurer outcome data were provided independently
and the outcome assessors were blinded to the baseline ÖMSQ
scores. All results were compiled at the studys completion. This
facilitated the blinding process as the time between screening and
compilation of the outcome results was maximized and compliant
with recent methodology recommendations (Hockings et al.,
2008).
n denotes number of participants
Fig. 1. Flow chart of ÖMSQ testing process in a general working musculoskeletal population.
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e122
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
Fig. 2. Örebro Musculoskeletal Screening Questionnaire (ÖMSQ).
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e12 3
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
Fig. 2. (Continued)
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e124
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
2.4. Assessments
Measurement and data collection were performed by self-report
questionnaires that included the ÖMSQ and patient reported
outcomes (PROs) for functional impairment and problem severity.
These PROs were completed at baseline then repeated at two-week
then four-week intervals until discharge or study completion at six
months. Absenteeism and cost data were provided by the partici-
pantsinsurer. Predictive ability was estimated from dichotomized
patient responses of less affectedand more affected(Field, 2005)
for six specic outcome traits.
1. Functional status was assessed by region specic PROs with
continuity of format and scale. This enabled direct comparison
and pooling of PRO scores: the Spine Functional Index (Gabel
et al., submitted for publication), the Upper Limb Functional
Index (Gabel et al., 2010) and the Lower Limb Functional Index
(Gabel et al., 2012). Each questionnaire had 25, three-point
scale questions with a minimal detectable change <8%. Status
was divided into recoveredat 10% or non-recoveredat
>10% (Ostelo et al., 2008).
2. Problem severity was assessed from an eleven-point global
numerical rating scale (NRS-global) where 0 ¼No problem and
10 ¼Maximum (Farrar, 2000) with a >10% cut-off for non-
recovered.
3. Absenteeism was assessed by paid-days-off(PDO) recorded by
the participantsinsurer and divided into PDO ¼0 (none)
versus PDO >0 (absenteeism).
4. Long term absenteeism was assessed by a cut-off of PDO >28
(Australias longest permitted continuous work period) (AIRC,
1999).
5. Total cost was assessed in Australian dollars from insurer
incurred expenses. This included all consultations, treatments,
investigations, wages and travel as calculated from the date of
original injury. For 20% of participants this was different from
their date of provocation or exacerbation. This cost was
dichotomized into high-cost $10,000 and low-cost <$1000.
The interim group was not evaluated to minimise the effect of
those with exacerbation, 85% of who were classied within the
high-cost group and the remainder who were within the
interim group.
6. Recovery time was the number of days required to reach 80%
recovery on the PRO measure (t
80
)(Gabel et al., 2006). This
functional status was lower than the recoveredclassication
of 10%, but was selected to maximise statistical correlation
(Gabel et al., 2011) and allow for symptom uctuation within
a chronic state (Young et al., 2011). This 80% level was dened
as a PRO score 20% (Ostelo et al., 2008). An a-priori minimum
correlation was required with the ÖMSQ baseline score of
r>0.70 (p<0.01) (Field, 2005).
Sensitivity and specicity were calculated at the different ÖMSQ
cut-off scores to determine the optimum threshold for each
outcome. The subsequent positive likelihood ratios (LRs) were
determined from: sensitivity/(1specicity). Negative LRs were not
calculated as only cut-off scores for trait presence were required.
2.5. Face and content validity
Two focus groups provided feedback and determined the
ÖMSQsface and content validity. A 12-person participants group
that contained four sets of three participants with symptoms from
the same region, the back, neck, upper limb and lower limb; and
a three-person therapists group. A two thirds majority consensus
opinion was required (nine participants and two therapists). The
recommended changes (detailed in the results) were implemented
(Fig. 2).
2.6. Psychometric characteristics
To determine the psychometric characteristics, validity and
reliability sub-groups were used. The full data sample was used for
all remaining characteristics (Fig. 1).
Construct validity (n¼143): criterion-related validity as
demonstrated by predictive validity calculated from the positive
LRs; divergent validity as demonstrated by a statistically signicant
t-test comparing ÖMSQ scores between groups with known posi-
tive and negative traits for each outcome excluding Recovery time;
Testeretest reliability (n¼60): used the ICC
2.1
at three days
(Shrout and Fleiss, 1979). Proportional representation by body
region reected the general compensation population (WorkCover-
Queensland, 2005) for the back (n¼24), neck, upper limb and
lower limb (n¼12 for each).
2.7. Practical characteristics
The original development study methodology was employed to
determine missing responses, completion time and scoring time.The
readability was determined from the FlescheKincaid scales of
Reading G radeand FleschReading Easeascalculated through word-
processing software (Kincaid et al.,1975;Paasche-Orlow et al., 2003).
2.8. Statistical analysis
The SPSS version 14.0 (Inc, Chicago, IL) was used with signi-
cance level set at p<0.01. Factor analysis used maximum likelihood
extraction with varimax rotation and coefcient suppression at
0.30 (Costello and Osborne, 2005).
3. Results
3.1. Focus group
The focus group consensus supported face and content validity.
Recommendations to improve the ÖMSQ format to facilitate accep-
tance and use in the clinical and research settings included: simpli-
fying the boxed format; shortening the introduction; use of single-
line summary statements for introductory sentences; clarication
of scale range through modication of descriptive anchors for
minimums and maximums; substitute daysfor weeks; and minor
wording changes to improve clarity for questions4, 11 and 13 (Fig. 2).
3.2. Psychometric characteristics
The ÖMSQ baseline responses are provided in Table 1. Normality
for these scores was examined through a normalised histogram,
ShapiroeWilk test (0.987,df ¼143, signicance <0.190), and
examination of Skewness and Kurtosis. These indicated ÖMSQ
baseline scores were distributed normally. Testeretest reliability was
high (r¼0.978, p<0.001) and comparable for each body region
where respective rvalues were: full spine ¼0.967, back ¼0.954,
neck ¼0.981, both limbs ¼0.978, upper limb ¼0.942 and lower
limb ¼0.984.
Predictive validity using the full sample of n¼143 was shown
through positive LRs (Table 2). The critical cut-off score was 114 ÖMSQ-
points for absenteeism, long term absenteeism, functional impair-
ment, severity and high cost. Other cut-offs were 83 ÖMSQ-points for
no absenteeismand 95 ÖMSQ-points for low cost. At three months,
the transition from subacute to chronic, 15.4% of participants were
non-recovered(spine ¼13.4%, c ervical ¼19.9% an d back ¼11.7% ;
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e12 5
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
extremities ¼16.9 %, arm ¼17.2%, le g ¼16.7%). At si x months 7.7% of
participants were non-recovered(spine ¼8.2%, cervical ¼6.6% and
back ¼8.8%; extremities ¼7.3 %, a rm ¼8.5%, leg ¼5.9%).
Discriminant validity was demonstrated by signicant t-tests
between outcome/non-outcome groups (Table 3). This was sup-
ported by a high Pearsons correlation between the ÖMSQ and t
80
(r¼0.73 p<0.01). Internal consistency of the total score was good
(Cronbachs
a
¼0.83), although individual constructs varied
(
a
¼0.26e0.83, Table 4).
The factor analysis correlation matrix was determined as suit-
able from the KaisereMeyereOklin value of 0.73 and highly
signicant Barlett Test of Sphericity (p<0.001). The ÖMSQ gener-
ated six factors based on the Scree plot (Cattell, 1966), eigenvalues
>1.0 ( Kaiser, 1960) and item-variance >5% (Field, 2005). The total
cumulative variance was 63.6%. The rotated six-component solu-
tion showed consistent loading within the designated constructs
(Table 4) with failure to load for two ÖMSQ-items (#1 and #12) and
cross-loading for two items (#15 and #16).
Table 1
Baseline ÖMSQ responses in a musculoskeletal working population.
Qu Response
format
Construct by
factor (#)
Variable name n(%) Mean
(SD)
Missing
items
1 Categories Other (5) Region
Back 77
(54%)
Neck 23
(17%)
Arm 35
(24%)
Leg 22
(12%)
Both sides 31
(22%)
Several areas 30
(21%)
2 Categories Personal (4) Absenteeism 1
0 days 3
(2%)
1e28 days 103
(72%)
>28 days 37
(26%)
30e10 Personal (4) Duration 4.1 (2.9)
40e10 Other (5) Burdensome 5.5 (2.9)
50e10 Other (5) Intensity acute 6.3 (2.0)
60e10 Problem (3) Severity chronic 6.0 (2.9) 2
70e10 Problem (3) Frequency 6.3 (3.2) 4
80e10 Psyche (2) Coping 4.8 (2.2)
90e10 Psyche (2) Anxiety 5.8 (2.9)
10 0e10 Psyche (2) Depression 4.5 (3.3)
11 0e10 Psyche (2) Recovery
expectation
problem
5.2 (2.9) 1
12 0e10 Personal (4) Recovery
expectation
work
1.6 (2.5)
13 0e10 Physical (1) Job satisfaction 3.7 (3.0) 1
14 0e10 Physical (1) Fear-avoidance:
activity
7.4 (2.4)
15 0e10 Fear-avoidance
(6)
Fear-avoidance:
stop
8.0 (2.5)
16 0e10 Fear-avoidance
(6)
Fear-avoidance:
not
work
6.8 (3.2)
17 0e10 Physical (1) Light work/chores 5.2 (3.2)
18 0e10 Physical (1) Walk/recreation 4.8 (3.3) 1
19 0e10 Physical (1) Home activity 4.6 (2.7)
20 0e10 Physical (1) ADL and social 5.1 (2.7)
21 0e10 Physical (1) Sleep/move in
bed
5.1 (2.9)
Total score 10 or 7.0%
Low risk 83 41
(29%)
Moderate risk
83e114
35
(24%)
High risk >114 67
(47%)
n¼143, ÖMSQ score range ¼40e174 points, mean ¼106.4 29.0. The six constructs are identied by name and number. Continuous variables are presented as means with
SD in parentheses and categorical variables as frequencies with percentages (%) in parentheses. Questions are rated 0e10 points where higher scores indicate increased risk.
Questions 8, 12, 13 and 17e21 were reversed and calculated as (10 escore).
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e126
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
3.3. Practical characteristics
Readability for the ÖMSQ was conrmed with Flesch Reading
Easeat 70% and FlescheKincaid gradeat 6.0. Missing responses
were at 5.6% (n¼10 in eight questionnaires, Table 1). Completion
time was 5.57 3.03 min and scoring time 1.28 0.10 min.
4. Discussion
4.1. Main ndings
The ÖMSQ was validated in an independent acute musculo-
skeletal work injured population. The psychometric and practical
characteristics were equivalent to those calibrated in the LBP
population (Gabel et al., 2011). The predictive ability for outcome
status at six months post-injury, as determined by the positive
LRs, was comparable to the LBP population. This reinforced the
development and validation study conclusions that the ÖMSQ
may be substituted for the original-ÖMPQ. This study conse-
quently provides the required research on the ÖMSQ, as a modi-
cation of the original-ÖMPQ, that has assessed and veried its
applicability in a broader general musculoskeletal population.
The ÖMSQ score predicted important outcomes related to
nancial costs, an important consideration for insurers (Westman
et al., 2008), and the time required to achieve 80% functional
status, an important consideration for predicting recovery (Young
et al., 2011). The optimal ÖMSQ cut-off score was 114 ÖMSQ-
points with sensitivity levels around 80%. This cut-off score was
comparable to the 110 ÖMSQ-points determined for LBP (Gabel
et al., 2011) and 109 ÖMSQ-points for whiplash (Gabel et al.,
2008). It marginally exceeded the 105e112 ÖMPQ-points cut-off
range found in several LBP studies (Linton and Hallden, 1998;
Grotle et al., 2007) but was markedly higher than the 90 ÖMPQ-
points from the Swedish spinal study (Linton and Boersma, 2003),
81 ÖMPQ-points from the Dutch LBP study (Heneweer et al., 2007)
and 72 ÖMPQ-points from the Dutch neck study (Vos et al., 2009).
However, it is lower than the 119e141 found in three musculo-
skeletal studies (Dunstan et al., 2005;Margison and French, 2007;
Westman et al., 2008). The established 109e114 ÖMSQ-points cut-
off range is midway between these original-ÖMPQ spine and
generalised populations ndings. This supports the use of the
ÖMSQ as an evolved version of the original-ÖMPQ and demon-
strates its improved consistency. These differences could be
attributed both geographical and cultural differences in the patient
population. However, they may also be a consequence of the
improved relevance of the individual ÖMSQ questions. The scores
may also be affected by therapist inuencessuch as treatment,
management and practitioners that catastrophize for their patients.
The ÖMSQ language changes were developed and tested in
Australia as a representative multicultural English-speaking
society. Consequently they should improve patient responses and
provide greater consistency between different population groups.
This potential explanation was supported by patient focus group
feedback and by the lower missing responses, 5.6%e6.6%,
compared to the original-ÖMPQ at 11.8% (Gabel et al., 2011)or
16%e25% (Grotle et al., 2006).
The results reported similar chronicity levels for the different
body regions. This implies that screening for long-term complica-
tions in both the extremities and the spine seem equally worth-
while. The ÖMSQ successfully identied a high proportion of non-
recoveredat six months through both constructs and specic
contributing items with higher means (Sattelmayer et al., 2011).
These ndings are consistent with previous original-ÖMPQ and
ALBPSQ studies where fear avoidance and pain that is widespread,
of a high level, or chronic, were prognostic for LBP at 12 months
(Grotle et al., 2010). This acute/chronic timeline was also identied
by Foster et al. (2010) who used the six month time frame to select
patients for targeted treatments. Foster also included coping
through perceived personal control and pain self-efcacy as deter-
mined in this study. By contrast, they found depression and fear
avoidance as not signicant. The ÖMSQ was specically designed to
broaden and evolve the original-ÖMPQ. This should increase its
suitability for general musculoskeletal populations including the
spine. However, it cannot account for all identied potential risk
factors such as illness (Foster et al., 2008), perceived injustice
(Sullivan et al., 2008), catastrophizing (Sullivan et al., 2001), beliefs
(Symonds et al., 1996) and expectations (Hilker et al., 2007).
4.2. Validation considerations
The prospective validation of a prognostic instrument is consid-
ered essential (Altman et al., 2009). To date, no published study has
assessed the psychometric and practical characteristics of the orig-
inal-ÖMPQ in an acute general musculoskeletal population, the
dened target population for which it is advocated by clinical
guidelines. These characteristics have only been investigated in LBP
populations in four separate data sets (Linton and Hallden, 1998;
Linton and Boersma, 2003;Grotleet al., 2005;Gabel et al., 2011). The
ÖMSQ modicationprocess broadened the application capacity to all
body regions (Margison and French, 2007), anticipated those in non-
working situations (Hurley et al., 2000) and would be eligible for
consideration by guidelines committees. This process also addresses
critiques concerning the development and validation methodology
used to produce the ALBPSQ and subsequently the original-ÖMPQ.
4.3. Sample size considerations
Sample sizes for one of our primary statistical analyses,
compared favourably with previous research. Only three original-
ÖMPQ studies considered multiple body regions of the spine, upper
and lower extremities. Only two had comparable sample sizes (to
Table 2
Predictive validity as determined from sensitivity and specicity cut-off scores.
Outcome ÖMSQ cut-off Sensitivity Specicity LRs
Absenteeism
(>0 paid days off)
114 60.5% 92.3% 7.9
Long term absenteeism
(28 paid days off)
114 78.3% 80.4% 4.0
Functional Status
(not recovered >10%)
114 79.1% 69.0% 2.5
Problem severity
(not recovered >10%)
114 79.1% 67.2% 2.4
High cost ($10,000) 114 85.3% 73.5% 3.2
No absenteeism (no days off) 83 53.8% 88.2% 4.5
Low cost (<$1000) 95 75.9% 76.6% 3.2
Risk categories Low Medium High
Absenteeism <83 8e114 >114
Cost <95 95e114 >114
Where: LR ¼Sensitivity/(1Specicity).
Table 3
Independent t-tests between outcome groups of known difference (n¼143).
Group dened by Positive trait ÖMSQ
score mean 95% CI
Negative trait
ÖMSQ score mean
95% CI
t-Statistic
a
Absenteeism (>0 PDO) 116.2 114e18.4 84.8 82.8e86.8 5.40
Long term (28 PDO)
absenteeism
126.4 124.7e128.1 93.3 91.1e95.5 6.96
Function (10%) 128 126.2e129.8 95.6 93.4e97.8 6.48
Severity (10%) 130.2 128.6e131.8 95.8 93.5e98.1 6.90
Cost ($10,000) 126.9 125.1e128.7 98.8 96.5e101.1 5.17
a
All tests were signicant (p<0.001).
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e12 7
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our n¼143) at both baseline and follow-up with n¼211 (Margison
and French, 2007) and n¼158 (Westman et al., 2008). The third
had n¼55 at nal follow-up (Dunstan et al., 2005). Of the
remaining 13 discrete data sets, where only LBP or spine with
referral pain to the limbs was considered, six studies had compa-
rable or larger sample sizes exceeding n¼140 (Appendix 1).
4.4. Psychometric properties
The high reliability (r¼0.978) in this study was comparable to
the original-ÖMPQ (r¼0.975) and the ÖMSQ (r¼0.982) devel-
opment study (Gabel et al., 2011). Consequently, wording modi-
cations alone were unlikely to have improved reliability which was
higher than previous original-ÖMPQ and ALBPSQ studies. A more
likely explanation was this studys use of the recommended ICC
2.1
method with a three-day interval in the target acute patient pop-
ulation (Shrout and Fleiss, 1979). The four previous reliability
studies found r¼0.90, ICC
1.1
at two days with chronic patients
(Grotle et al., 2006), r¼0.85, ICC
2.1
at one week with acute patients
(Vos et al., 2009), r¼0.83, Pearsons product-moment at one week
in chronic patients (Linton and Hallden, 1998), and r¼0.80, Pear-
sons product-moment at 2e4 weeks in sub-acute to chronic
patients (Linton and Boersma, 2003).
This studys demographic details were comparable with
previous ndings (Hockings et al., 2008) as were the baseline
percentage of non-recoveredpatients (Heneweer et al., 2007) and
absenteeism levels (Grotle et al., 2007). However, those non-
recoveredat six months (7.7%) were considerably lower than
previously reported at 15%e70% and likely to be due to different
denitions of non-recoveredand the outcome criteria used.
Factor analysis with maximum likelihood extraction showed
a six-factor model aligned to the theoretical constructs (Linton and
Hallden, 1998). Previous studies showed poorer t to this proposed
model, including less factors (Grotle et al., 2006), and items
(Westman et al., 2008), specically for Distressand Fear-avoid-
ance. This may be attributed to principal component analysis,
which is inappropriate for normally distributed populations
(Fabrigar et al., 1999), and use of chronic LBP participants (Westman
et al., 2008). This studys six factors explained 63% of variance, an
acceptable statistical level (Henson and Roberts, 2006). This was
higher than the 49% reported by Grotle et al. (2006) but comparable
to the 59.8% found by Heneweer (2010) and marginally lower than
the 69% found by Westman et al. (2008) on 17 items. Our analysis
showed some support for a four construct model which suggests
a shorter more practical tool, perhaps with 12-items, could be
developed and investigated. This would facilitate early recognition
of the critical underlying constructs that lead to delayed recovery.
Such recognition can optimize referral to specic targeted inter-
ventions that facilitate improved outcomes (Foster et al., 2010).
4.5. Limitations
The ndings cannot be extrapolated beyond the time frame of
the six month follow-up. The study included participants with
provocation or exacerbation of a previous injury. This was a con-
founding factor for cost calculations for the interim group and high-
cost groups as it included participants with insurer calculated costs
that were incurred prior to the studysdened date of inclusion.
Entitlement to wage-related compensation may also be a potential
confounder for individual recovery however its inuence was
beyond the scope of this study.
4.6. Strengths
The ÖMSQ sought to improve upon the original-ÖMPQ for use in
a broader musculoskeletal population. It provided greater diversity
in work status, body regions and symptoms. The ÖMSQ psycho-
metric and practical characteristics were consistent with the orig-
inal development study in an LBP population (Gabel et al., 2011).
There was comparable reliability but at a value higher than repor-
ted in previous original-ÖMPQ studies.
4.7. Implications for practice
The ÖMSQ provided reference cut-off scores that supplement
clinical judgement. These are conducive to everyday primary care as
they complement and facilitate standard clinical examination. This
includes a cliniciansdecision to wait and seeor refer to specialists,
psychologists, counsellors or rehabilitation. This referral decision
could be assisted by total construct scores and individual proles
Table 4
ÖMSQ factor analysis loading in a working musculoskeletal population.
1 Physical function 2 Psychological 3 Problem 4 Personal 5 Other 6 Fear-avoidance
Q20 ADL and social 0.944
Q18 Walk or light recreational activity 0.775
Q21 Home activity 0.720
Q17 Light work e1 h 0.719
Q19 Sleep or movement in bed 0.510
Q14 Fear-avoidance: activity makes worse 0.426
Q13 Job satisfaction 0.333
Q10 Depression 0.843
Q9 Anxiety 0.757
Q11 Recovery expectation: of problem 0.470
Q12 Recovery expectation: of work <0.300
Q1 Region <0.300
Q7 Problem severity echronic 0.890
Q6 Problem frequency 0.665
Q3 Problem duration 0.807
Q2 Absenteeism 0.729
Q5 Problem intensity eacute 0.954
Q4 Burdensome 0.392
Q16 Fear-avoidance: stop work/ADL if worse 0.387 0.595
Q15 Fear-avoidance: stop if activity if worse 0.384 0.427
Q8 Cope with problem 0.415
a
Internal consistency by construct
a
¼0.83 0.69 0.77 0.72 0.55 0.26
Total tool
a
¼0.82
Factor analysis used maximum likelihood extraction and varimax rotation; 21 items (n¼143), suppression at 0.300.
a
Q8 loading has been reversed by multiplying by 1.
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e128
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determined by the response to specic questions and constructs
(Sattelmayer et al., 2011). The determined cut-off scores could assist
in minimising incorrect prognosis classication (Hill et al., 2010).
This would enable at-risk patients to be identied and appropriately
referred at an earlier stage. The ÖMSQ scores are interchangeable
with the original-ÖMPQ due to the systematic modication process
used in the ÖMSQ development. This is supported by the excellent
criterion validity (r¼0.97) previously demonstrated (Gabel et al.,
2011). These considerations should facilitate acceptance of the
ÖMSQ in clinical, research and insurance settings which minimize
potential data loss for existing systems that use the original-ÖMPQ.
4.8. Implications for research
Further research should seek to validate these ndings in both
general and specic subgroup populations, including the limbs, the
elderly and sports injury populations. This may lead to a more
accurate prediction of chronicity (Hockings et al., 2008) and indi-
vidual recovery time (Gabel et al., 2006). Furthermore, systematic
reviews of predictive validity (Hockings et al., 2008) and meta-
analysis of screening and outcome scores, including individual
proles and item construct scores (Sattelmayer et al., 2011), should
be extended from the original-ÖMPQs spinal populations to
general musculoskeletal populations. In addition, investigation of
the effectiveness of specic interventions targeting screening
questionnaire constructs should be considered. A shortened 12-
item instrument could be considered in order to improve clinical
practicality through reduced patient and clinician burden yet retain
representation of the six constructs determined by the focus group
and factor analysis. This concept is supported by a recent LBP
version (Linton et al., 2011) and potential item redundancy shown
through factor analysis and loading inconsistencies between the
ÖMSQ and original-ÖMPQ.
5. Conclusions
The ÖMSQ is a valid and reliable instrument that can assist in
identifying acute musculoskeletal work injured patients in
a primary care setting that are at risk of unfavourable outcome at
six months. This may facilitate early specialist referral and optimize
outcomes from targeted intervention strategies.
Competing interests
None.
Acknowledgements
This research was supported by an Australian Commonwealth
Governments Department of Aging, PHC-RED program Grant.
Research support and ethics approval was provided by the
University of the Sunshine Coast. We thank all participating
patients, general practitioners, and therapists.
Appendix 1
Comparison of data between ÖMSQ and previous original-ÖMPQ studies, modied ÖMPQ versions and the ALBPSQ.
Author Journal Questionnaire Country Patient type Region nat
baseline
nat
follow-up
Mean/Median Score range Cut-off
Linton and
Hallden, 1998
Clin J Pain ALBPSQ Sweden Acuteesubacute Spine and
shoulders
147 137 (93.2%) 104 45e176 105
Kendall, 1999 IASP 9th Cong ALBPSQ New
Zealand
Acute LBP Not stated Not stated Not stated Not stated 105
Hurley
et al., 2000
Clin J Pain ALBPSQ Northern
Ireland
Acute LBP 118 90 (76.3%) Median 113.5 49e208 112
Hurley
et al., 2001
Clin J Pain ALBPSQ Northern
Ireland
1 year review LBP 118 90 (76.3%) Median 113.5 49e208 112
Linton and
Boersma, 2003
Clin J Pain ÖMPQ Sweden Acuteesubacute Spine and
shoulder
122 107 (87.7%) 95 32e166 90
Dunstan
et al., 2005
Int J
Rehabil Res
Mod-ÖMPQ Australia
(NSW)
Chronic General 196 55 (28.1%) 99.6 Not stated 119
Nordeman
et al., 2006
Clin J Pain ÖMPQ Sweden Subacute LBP 60 53 (88.3%) 97.5 80e115 105
Grotle
et al., 2005
Spine ALBPSQ Norway 1 year review LBP 123 112 (91%) Acute ¼78.9
Chronic ¼115
45e125 105
Grotle
et al., 2006
Clin J Pain ALBPSQ Norway Mixed LBP 123 112 (91%) Acute ¼78.9
Chronic ¼115
45e125 105
Grotle
et al., 2007
Eur J P ALBPSQ Norway 1 year review LBP 123 112 (91%) Acute ¼78.9
Chronic ¼115
45e125 105
Margison and
French, 2007
J Occup
Environ Med
Mod-ÖMPQ Canada Chronic General 211 211 (100%) 123/220 Not stated 147/220
Jellema
et al., 2007
Br J Gen Pract ÖMPQ Holland Acuteesubacute LBP 314 298 (94.9%) Not stated Not stated Low ¼90
High ¼105
Heneweer
et al., 2007
Spine ÖMPQ Holland Acuteesubacute LBP 66 56 (84.8%) Recovered ¼67
Not ¼81
41e106 81
Gabel
et al., 2008
Int J Rehab Res ÖMSQ Australia
(Qld)
Acuteesubacute WAD 33 30 (90%) 95 46e179 109
Grimmer-Somers
et al., 2008
J Pain Res ALBPSQ New Zealand Acute LBP 328 328 (100%) Not Stated 10e146 Low ¼50,
High >105
Med ¼50e89
Westman
et al., 2008
Eur J Pain Mod-ÖMPQ Sweden Chronic General 158 149 (94.3%) 121 Not stated >117 and <139
(continued on next page)
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Appendix 2. Glossary of terms.
(continued )
Author Journal Questionnaire Country Patient type Region nat
baseline
nat
follow-up
Mean/Median Score range Cut-off
Hill et al., 2009 Eur J Pain ÖMPQ UK Not stated LBP 131 130 (99.2%) Not noted Not stated Low ¼90
High ¼112
Vos et al., 2009 J Manip
Physiol Ther
ALBPSQ Holland Acuteesubacute Neck 187 180 (96.3%) 71.3 14e151 72/200
Maher and
Grotle, 2009
Clin J Pain ÖMPQ Norway
/Australia
(NSW)
Mixed LBP 259 230 (88.9%) 75.2 and 84.6 Not stated Not stated
Heneweer
et al., 2010
Spine ÖMPQ Holland Acuteesubacute LBP 66 56 (84.8%) Recovered ¼67 Not ¼85 41e106
Gabel et al., 2011 Eur Spine J ÖMSQ Australia (Qld) Acuteesubacute LBP 106 106 (100%) 112.5 40e174 110
This article Man Ther ÖMSQ Australia (Qld) Acuteesubacute General 143 143 (100%) 106.4 40e174 114
Barlett Test of Sphericity: preliminary test conducted to determine if three or more independent samples are homogenous or
variant before proceeding.
Cronbachi’s alpha coefficient: test for a model or survey’s internal consistency.
Clinimetric properties: assessment or description of symptoms, signs and findings by means of scales, indices and other
quantitative instruments ee.g. psychometric and practical characteristics of an outcome measure.
Concurrent validity: method of determining validity as the correlation of the test with scores from known valid measures.
Pearson’s Correlation Coefficient r value most commonly used
Construct validity: degree to which an instrument accurately measures the underlying theoretical or hypothetical constructs of
concern including the normality of baseline. Distribution patterns, the presence of floor and ceiling effects and how well the tool
performs in comparison to instruments of a similar (convergent validity) and/or dissimilar (divergent validity) purpose and
dimension.
Content validity: method of establishing validity based on expert judgement that the content of the measure is consistent with
what is to be measured.
Convergent validity: type of validity determined by hypothesizing and examining the overlap between two or more tests that
presumably measure the same construct
Criterion validity: degree to which a measure or test correlates with other measures or tests of the same construct assessed
concurrently or in future; ability of a test to predict a criterion.
Discriminant validity: degree to which an operation is not similar to or diverges from other operations that it theoretically should
not be similar to.
Divergent validity: hypothesizing and examining differential relations between a test and measures of similar or different
constructs; the ability of a scale to discriminate between patients with maximal and minimal functional deficits.
Effect size: mean change scores divided by the standard deviation of the baseline scores.
Eigenvalue: value such that a given square matrix minus that number times the identity matrix has a zero determinant. A cut-off
value of 1.0 is often considered critical (in factor analysis).
Face/logical validity: overall appearance of the test; extent to which a test appeals to test takers.
Factor structure: mathematical procedure to reduce large amounts of data into a structure that can be more easily studied
Flesch-Kincaid scale: ‘Reading Ease’ and ‘Grade Level’ use word length and sentence length to indicate the comprehension
difficulty when reading text, the scales are invesely related
Intention-to-treat-analysis: analysis based on the initial treatment intent, not on that eventually administered, withdrawal from
treatment or deviation from the protocol
Intraclass correlation coefficient (ICC): descriptive statistic for quantitative measurements to indicate how strongly units in the
same group resemble each other.
KaisereMeyereOklin value: measure of ‘Sampling Adequacy’ should exceed the recommended minimum value such as 0.6 or 0.8
depending on the sample size and requirements.
KolmogoroveSmirnov (KeS) test for normality: statistical nonparametric method for comparing the empirical distribution
functions of two samples, i.e. to quantify distances between the sample and the reference distribution.
Likelihood Ratio (LR): Sensitivity/(1 eSpecificity).
Maximum likelihood extraction: method of extracting common variables to make multivariate data simpler and easier to
understand through correlations between factors, but requires the assumption of multivariate normality.
Measurement of outcome measures: 25-item dichotomous tool to assist quantification of the quality of a patient reported
outcome (PRO) measurement questionnaire.
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References
Accident Compensation Corporation (ACC) of New Zealand. New Zealand acute low
back pain guide, incorporating the guide to assessing yellow ags in acute low
back pain. New Zealand Work Health Authority; 2004.
Altman DG, Vergouwe Y, Royston P, Moons KGM. Prognosis and prognostic
research: validating a prognostic model. BMJ 2009;338(b605):1432e5.
Australian Industrial Relations Commission (AIRC). Tugboat Industry Award: AIRC
web site; 1999.
Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of
low back pain in the workplace: a systematic review. J Occup Rehabil 2009;
19(1):8e24.
Brown G. The Örebro Musculoskeletal Pain Questionnaire. Occup Med 2008;58(6):
447e8.
Calley D, Jackson S, Collins H, George SZ. Identifying patient fear-avoidance beliefs
by physical therapists managing patients with low back pain. J Orthop Sports
Phys Ther 2010;40(12):774e83.
Cattell RB. The scree test for the number of factors. Multivar Behav Res 1966;1:
245e76.
Costello AB, Osborne J. Best practices in exploratory factor analysis: four recom-
mendations for getting the most from your analysis. Pract Assess Res Eval 2005;
10(7):1e9.
Driessen MT, Anema JR, Proper KI, Bongers PM, van der Beek AJ. Stay@Work:
participatory ergonomics to prevent low back and neck pain among workers:
design of a randomised controlled trial to evaluate the (cost-) effectiveness.
BMC Musculoskelet Disord 2008;9:145.
Dunstan D, Covic T, Tyson GA, Lennie IG. Does the Orebro Musculoskeletal Pain
Questionnaire predict outcomes following a work-related compensable injury?
Int J Rehabil Res 2005;28(4):369e70.
Ekman M, Jonhagen S, Hunsche E, Jonsson L. Burden of illness of chronic low back
pain in Sweden: a cross-sectional, retrospective study in primary care setting.
Spine 2005;30(15):1777e85.
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of explor-
atory factor analysis in psychological research. Psychol Methods 1999;4(2):
272e99.
Farrar JT. What is clinically meaningful: outcome measures in pain clinical trials.
Clin J Pain 2000;16(Suppl. 2):S106e12.
Field A. Discovering statistics using SPSS. 2nd ed. London: SAGE Publications Ltd;
2005.
Foster NE, Bishop A, Thomas E, Main C, Horne R, Weinman J, et al. Illness
perceptions of low back pain patients in primary care: what are they, do
they change and are they associated with outcome? Pain 2008;136(1e2):
177 e87.
Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological
obstacles to recovery in low back pain patients in primary care. Pain 2010;
148(3):398e406.
Gabel CP, Burkett B, Neller A, Yelland M. Can long term impairment in general
practitioner whiplash patients be predicted using screening and patient report
outcomes? Int J Rehabil Res 2008;31(1):79e80.
Gabel CP, Melloh M, Burkett B. The lower limb functional index: development and
validation of the clinimetric properties and practical characteristics. Phys Ther
2012;92(1):98e110.
Gabel CP, Melloh M, Burkett B, Michener LA. The Spine Functional Index (SFI):
development and clinimetric validation of a new whole-spine functional
outcome measure. Spine J, submitted for publication.
Gabel CP, Melloh M, Yelland M, Burkett B, Roiko A. Predictive ability of a modied
Örebro Musculoskeletal Pain Questionnaire in an acute low back pain working
population. Eur Spine J 2011;20(3):449e57.
Gabel CP, Michener LA, Melloh M, Burkett B. Modication of the upper limb func-
tional index to a three-point response improves clinimetric properties. J Hand
Ther 2010;23(1):41e52.
Gabel P, Barden L, Burkett B, Neller L. Integrating injury screening with measure-
ment and monitoring: a conceptual approach using a patient global assessment
of body and limbs scale. S Afr J Physiother 2006;62(4):2e7.
Grimmer-Somers K, Prior M, Robertson J. Yellow ag scores in a compensable
New Zealand cohort suffering acute low back pain. J Pain Res 2008;1:
15e25.
Grotle M, Brox JI, Glomsrød B, Lønn JH, Vøllestad NK. Prognostic factors in rst-time
care seekers due to acute low back pain. Eur J Pain 2007;11(3):290e8.
Grotle M, Brox JI, Veierod MB, Glomsrod B, Lonn JH, Vollestad NK. Clinical course
and prognostic factors in acute low back pain: patients consulting primary care
for the rst time. Spine 2005;30(8):976e82.
Grotle M, Forster N, Dunn K, Croft P. Are prognostic indicators for poor outcome
different for acute and chronic low back pain consulters in primary care? Pain
2010;151(3):790e7.
Grotle M, Vøllestad N, Brox JI. Screening for yellow ags in rst-time acute low back
pain: reliability and validity of a Norwegian version of the Acute Low Back Pain
Screening Questionnaire. Clin J Pain 2006;22(5):458e67.
Heneweer H, Aufdemkampe G, van Tulder MW, Kiers H, Stappaerts KH, Vanhees L.
Psychosocial variables in patients with (sub)acute low back pain: an inception
cohort in primary care physical therapy in The Netherlands. Spine 2007;32(5):
586e92.
Heneweer H, van Woudenberg NJ, van Genderen F, Vanhees L, Wittink H.
Measuring psychosocial variables in patients with (sub) acute low back pain
complaints, at risk for chronicity: a validation study of the Acute Low Back Pain
Screening Questionnaire-Dutch language version. Spine 2010;35(4):447e52.
Meng’s test of significance: unbiased significance test
Minimal detectable change (MDC): minimal change that falls outside the measurement error in the score of an instrument.
Minimal clinically important difference (MCID): smallest improvement considered worthwhile by a patient.
Pearson coefficient: represents the relationship between two variables that are measured on the same interval or ratio scale.
Principle component analysis (PCA): method of extracting common variables to make multivariate data simpler and easier to
understand, but requires no distributional assumptions.
Psychometric properties: elements contributing to the statistical adequacy of the instrument in terms of reliability, validity and
internal consistency.
Reliability: precision or consistency of a measure determined by the variance of repeated measurements, the degree to which
a test is free of random error.
Responsiveness: ability of a scale to measure clinical change.
Scree plot curve: plots the extracted components as X and Y axis, with the critical point being where drop ceases and the curve
‘inflects’ towards lesser values (in factor analysis).
Sensitivity: proportion of cases with the condition that the test correctly detects, e.g. being absent for the stated period at
a specific cut-off score.
Specificity: proportion of cases without condition that the test correctly detects, eg. being absent for the stated period correctly
classified at a specific cut-off score.
Standard error of the measurement (SEM): estimate of error to use in interpreting an individual’s test score.
Standard response mean (SRM): mean change score divided by standard deviation of the change score.
t-statistic: ratio of the coefficient to its standard error; how extreme a statistical estimate is.
Varimax rotation: (in factor analysis) variance maximizing rotation of the original variable space, rotation of the vector of factors to
find key combinations that simplify the analysis.
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e12 11
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
Henson RK, Roberts JK. Use of exploratory factor analysis in published research:
common errors and some comment on improved practice. Educ Psychol Meas
2006;66(3):393e416.
Hilker R, Bachmann LM, Heitz C, Lorenz T, Joronen H, Klipstein A. Value of
predictive instruments to determine persisting restriction of function in
patients with subacute non-specic low back pain. Systematic review. Eur
Spine J 2007;16(11):1755e75.
Hill J, Vohora K, Dunn K, Main C, Hay EM. Comparing the STarT back screening tools
subgroup allocation of individual patients with that of independent clinical
experts. Clin J Pain 2010;26(9):783e7.
Hill JC, Dunn KM, Main CJ, Hay EM. Subgrouping low back pain: a comparison of the
STarT Back Tool with the Orebro Musculoskeletal Pain Screening Questionnaire.
Eur J Pain 2009;14(1):83e9.
Hockings RL, McAuley JH, Maher CG. A systematic review of the predictive ability
of the Orebro Musculoskeletal Pain Questionnaire. Spine 2008;33(15):
E494e500.
Hurley DA, Dusoir TE, McDonough SM, Moore AP, Linton SJ, Baxter GD. Biopsy-
chosocial screening questionnaire for patients with low back pain: preliminary
report of utility in physiotherapy practice in Northern Ireland. Clin J Pain 2000;
16(3):214e28.
Hurley DA, Dusoir TE, McDonough SM, Moore AP, Baxter GD. How effective is the
acute low back pain screening questionnaire for predicting 1-year followup in
patients with low back pain? Clin J Pain 2001;17(3):256e63.
Jellema P, van der Windt DA, van der Horst HE, Stalman WA, Bouter LM. Prediction
of an unfavourable course of low back pain in general practice: comparison of
four instruments. Br J Gen Pract 2007;57(534):15e22.
Johnston V. Clinimetrics: }
Orebro Musculoskeletal Pain Screening Questionnaire.
Aust J Physiother 2009;55(2):141.
Kaiser HF. The application of electronic computers to factor analysis. Educ Psychol
Meas 1960;20:141e51.
Kendall N. Screening and early intervention: the New Zealand experience. The
Ninth World Congress of the International Association for the Study of Pain;
1999. Vienna, Austria: IASP ePress; 1999.
Kincaid JP, Fishburne RP, Rogers RL, Chissom BS. Derivation of new readability
formulas (automated readability index, fog count, and Flesch reading ease
formula) for Navy enlisted personnel. Research Branch report. Memphis: Naval
Air Station; 1975. 8e75.
Liebenson C, Yeomans S. Assessment of psychosocial risk factors of chronicity e
yellow ags. In: Liebenson C, editor. Rehabilitation of the spine: a practitioners
manual. Baltimore, MD: Lippincott, Wilkins and Williams; 2007. p. 183e200.
Linton SJ. Manual for the Orebro Musculoskeletal Pain Screening Questionnaire: the
early identication of patients at risk of chronic pain. Orebro Sweden: Orebro
University; 1999. p. 71.
Linton SJ, Boersma K. Early identication of patients at risk of developing a persis-
tent back problem: the predictive validity of the Orebro Musculoskeletal Pain
Questionnaire. Clin J Pain 2003;19(2):80e6.
Linton SJ, Hallden K. Can we screen for problematic back pain? A screening ques-
tionnaire for predicting outcome in acute and subacute back pain. Clin J Pain
1998;14(3):209e15.
Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Örebro
Musculoskeletal Pain Screening Questionnaire. Spine (Phila Pa 1976) 2011;
36(22):1891e5.
Maher CG, Grotle M. Evaluation of the predictive validity of the Orebro Musculo-
skeletal Pain Screening Questionnaire. Clin J Pain 2009;25(8):666e70.
Margison DA, French DJ. Predicting treatment failure in the subacute injury phase
using the Orebro Musculoskeletal Pain Questionnaire: an observational
prospective study in a workerscompensation system. J Occup Environ Med
2007;49(1):59e67.
Melloh M, Elfering A, Chapple CM, Käser A, Rolli Salathé C, Barz T, et al. Prognostic
occupational factors for persistent low back pain in primary care. Int Arch
Occup Environ Health 2012. Epub 2012 Mar 21.
Melloh M, Elfering A, Egli Presland C, Röder C, Hendrick P, Darlow B, et al. Predicting
the transition from acute to persistent low back pain. Occup Med (Lond) 2011;
61(2):127e31.
Nordeman L, Nilsson B, Möller M, Gunnarsson R. Early access to physical therapy
treatment for subacute low back pain in primary health care: a prospective
randomized clinical trial. Clin J Pain 2006;22(6):505e11.
NHMRC, (National Health and Medical Research Council), Australian Acute
Musculoskeletal Pain Guidelines Group. Evidence-based management of acute
musculoskeletal pain. Sydney: NHMRC; 2003. p. 259.
Ostelo RW, Deyo R, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting
change scores for pain and functional status in low back pain: towards interna-
tional consensus regarding minimal important change. Spine 2008;33(1):90e4.
Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-
consent forms as compared with actual readability. N Engl J Med 2003;
348(8):721e6.
SattelmayerS, Lorenz T, RöderC, Hilker R. Predictivevalue of the Acute Low BackPain
Screening Questionnaire and the Örebro Musculoskeletal Pain Screening Ques-
tionnaire for persisting problems. Eur Spine J 2011. E-version Pre-publication.
Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol
Bull 1979;86(2):420e8.
Sullivan M, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, et al.
Theoretical perspectives on the relation between catastrophizing and pain. Clin
J Pain 2001;17:52e64.
Sullivan MJ, Adams H, Horan S, Maher D, Boland D, Gross R. The role of perceived
injustice in the experience of chronic pain and disability: scale development
and validation. J Occup Rehabil 2008;18(3):249e61.
Sullivan MJ, Adams H, Martel MO, Scott W, Wideman T. Catastrophizing and
perceived injustice: risk factors for the transition to chronicity after whiplash
injury. Spine (Phila Pa 1976) 2011;36(Suppl. 25):S244e9.
Symonds TL, Burton AK, Tillotson KM, Main CJ. Do attitudes and beliefs inuence
work loss due to low back trouble? Occup Med 1996;46(1):25e32.
van Tulder M, Becker A, Beckering T, Breen A, Gil del Real MT, Hutchinson A, On
behalf of the COST BB13 Working Group on Guidelines for the Management of
Acute Low Back Pain in Primary Care, et al. Chapter 3. European guidelines for
the management of acute nonspecic low back pain in primary care. Eur Spine J
2006;15(Suppl. 2):S169e91.
Vos CJ, Verhagen AP, Koes BW. The ability of the Acute Low Back Pain Screening
Questionnaire to predict sick leave in patients with acute neck pain.
J Manipulative Physiol Ther 2009;32(3):178e83.
Westman A, Linton SJ, Ohrvik J, Wahlén P, Leppert J. Do psychosocial factors predict
disability and health at a 3-year follow-up for patients with non-acute
musculoskeletal pain? A validation of the Orebro Musculoskeletal Question-
naire. Eur J Pain 2008;12(5):641e9.
WorkCover Queensland. A step ahead eannual report 2004e2005. p. 28 statistics.
Brisbane: WorkCover Queensland; 2005. p. 38.
WorkCover South Australia. TREAT, Treatment Resource And Education Assistance
Tool. Adelaide: WorkCover SA; 2007.
Workers Compensation Authority of New South Wales. Management of soft tissue
injuries. Sydney: Workercover NSW; 2006.
WorkSafe Victoria and the Trafc Accident Commission of Victoria (TAC),
Davidson M, Pizzari T, Coburn P, Boyd L. Integrating risk assessment into clinical
practice. Melbourne: WorkSafe Victoria; 2007.
Young AE, Wasiak R, Phillips L, Gross DP. Workersperspectives on low back pain
recurrence: "it comes and goes and comes and goes, but its always there". Pain
2011;152(1):204e11.
C.P. Gabel et al. / Manual Therapy xxx (2012) 1e1212
Please cite this article in press as: Gabel CP, et al., The Örebro Musculoskeletal Screening Questionnaire: Validation of a modied primary care
musculoskeletal screening tool in an acute work injured population, Manual Therapy (2012), http://dx.doi.org/10.1016/j.math.2012.05.014
... aspx)). Measures included self-reported pain-related sickness absence in the previous 12 weeks (days) [22], the number of days with low back pain (LBP) in the previous four weeks and the number of days with neck/shoulder pain (NSP) in the previous four weeks measured by a slightly modified Nordic Musculoskeletal Questionnaire (NMQ) [23] (see Supplementary material). The validity and reliability of NMQ has been found to be acceptable and the NMQ has also been used extensively throughout the world and is simple to administer and well accepted by workers [24]. ...
... Analyses were conducted using three further outcomes: LBP intensity (0-10), NSP intensity (0-10) [23] and total sickness absence in the previous 12 weeks (no. of days) [22]. Pain intensity scales were linked to the 'number of days with pain' questions. ...
... For the eldercare employees, we included sociodemographic information (i.e., age, sex), work-related characteristics (i.e. type of job and type of ward), and health and lifestyle (i.e., general health [25], LBP and NSP [23], pain-related sickness absence [22], body mass index (BMI) and smoking). For the managers, we included demographic information (age) and work-related characteristics (i.e. ...
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Purpose Managers’ knowledge and behaviors in addressing musculoskeletal pain and sickness absence is not well understood. We investigated the association between managers’ knowledge and behaviours in relation to employees’ pain and their future risk of musculoskeletal pain and associated sickness absence. Methods The prospective study included 535 eldercare employees, and 42 managers from 20 nursing homes. Managers’ self-reported knowledge and behaviors in relation to employees’ pain were grouped using Principal Components Analysis. Eldercare employees reported pain-related sickness absence, and number of days with musculoskeletal pain repeatedly over 1 year. We investigated associations using mixed-effects regression models. Results We identified four types of managers’ knowledge and behaviors: 1) Pain-prevention (actions for prevention of employee pain), 2) Pain-management (actions to assist employees manage pain), 3) Pain-entitlements (communicating entitlements to employees with pain), and 4) Pain-accommodations (ability to facilitate workplace accommodations for employees with pain). The employees of managers with higher scores on knowledge of pain-entitlements reported fewer days of pain-related sickness absence (β = -0.62; 95%CI [-1.14; -0.10]). The employees of managers with higher scores on pain-management were more likely to report low back pain (β = 0.57; 95%CI [0.02; 1.11]). We found several key associations between the knowledge and behaviors measures and pain-related sickness absence (interactions). Conclusion Managers’ knowledge and behaviors in relation to employees’ pain were associated with employees’ future musculoskeletal pain and sickness absence. The relationships are complex, suggesting that a multifaceted approach is needed to ensure that managers are adequately informed on how to manage and accommodate employees with musculoskeletal pain to reduce sickness absence.
... The Orebro Musculoskeletal Pain questionnaire is among the widely used scale and is validated and translated in various languages and is known to predict absenteeism, chronicity, pain and impairment [2] . The original Orebro Musculoskeletal Pain Questionnaire was developed by Linton et al. in the year 1998 and was used to identify patients at risk of persistent pain. ...
... The original scale raised several points which included the incomplete clinimetric development process and restricted approach. There were additional points that emerged which included the low content validity and the main concern of not including general musculoskeletal injuries and non-working population [2] . As there were several critiques which came up, there was a need to modify the original Orebro Musculoskeletal Pain Questionnaire (OMPQ). ...
... As there were several critiques which came up, there was a need to modify the original Orebro Musculoskeletal Pain Questionnaire (OMPQ). The original Orebro Musculoskeletal Pain Questionnaire was then developed and modified to Orebro Musculoskeletal Screening Questionnaire by Charles Philip Gabel through changes to its wording and item content into 21-item OMSQ [2]. In order to improve practicality and reduce the burden on patients and clinicians, a 12-item version (OMSQ-12) was formed by the same author in 2013. ...
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Background: The Orebro Musculoskeletal Screening Questionnaire-12 item (H-OMPQ-12) is used to assess absenteeism, chronicity, pain and impairment in patients with musculoskeletal dysfunction. However, this questionnaire is not available for Hindi speaking population. Thus the aim of this study is to cross-culturally adapt the Orebro Musculoskeletal Screening Questionnaire 12-item into a Hindi language and to assess its psychometric properties (validity and reliability).
... In cases where studies reported on blinding of outcome assessment, researchers usually applied blinding. 24 ...
... The number of events (ie, the number of individuals with the outcome event) was not reported in a large number of studies 5,14,[21][22][23][24][25]33,38,64,66,80 and considered inappropriate in 5 studies. 28,31,44,63,81 These studies reported ,20 events, raising the issue of overfitting (ie, the probability of an event is typically underestimated in low-risk patients and overestimated in highrisk patients). ...
... Studies sometimes performed multiple follow-ups, reporting results on the predictive validity for one or only a selection of follow-ups (eg, follow-ups at 2-and 4-week intervals until discharge or study completion at 6 months, report of results for 6-month follow-up). 24 Time between screening and outcome assessment was considered inappropriate when results only reported on follow-ups of ,3 months, as chronic pain is defined as pain $3 months (eg, six weeks). 66 Follow-ups .12 ...
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Screening tools allowing to predict poor pain outcomes are widely used. Often these screening tools contain psychosocial risk factors. This review (1) identifies multidimensional screening tools that include psychosocial risk factors for the development or maintenance of pain, pain-related distress, and pain-related disability across pain problems in adults, (2) evaluates the quality of the validation studies using Prediction model Risk Of Bias ASsessment Tool (PROBAST), and (3) synthesizes methodological concerns. We identified 32 articles, across 42 study samples, validating 7 screening tools. All tools were developed in the context of musculoskeletal pain, most often back pain, and aimed to predict the maintenance of pain or pain-related disability, not pain-related distress. Although more recent studies design, conduct, analyze, and report according to best practices in prognosis research, risk of bias was most often moderate. Common methodological concerns were identified, related to participant selection (eg, mixed populations), predictors (eg, predictors were administered differently to predictors in the development study), outcomes (eg, overlap between predictors and outcomes), sample size and participant flow (eg, unknown or inappropriate handling of missing data), and analysis (eg, wide variety of performance measures). Recommendations for future research are provided.
... For the OMPSQ, many other work-related outcomes have been studied (Table 1). For absenteeism 1 day at 6 months [15,31,32,37], the AUC was between 0.74 (0.64-0.84) [15] and 0.86 (0.76-0.96) [31]. For absenteeism 30 days at 6 months [31][32][33][34]37], the AUC was between 0.80 (0.66-0.93) [33] and 0.88 (0.81-0.96) [34]. ...
... For absenteeism 1 day at 6 months [15,31,32,37], the AUC was between 0.74 (0.64-0.84) [15] and 0.86 (0.76-0.96) [31]. For absenteeism 30 days at 6 months [31][32][33][34]37], the AUC was between 0.80 (0.66-0.93) [33] and 0.88 (0.81-0.96) [34]. The longest follow-up periods were also studied, with an AUC between 0.72 (0.57-0.86) [33] and 0.75 (0.67-0.84) [38] for absenteeism 30 days at 12 months [33,38] and an AUC of 0.69 (0.59-0.78) for absenteeism 30 days at 24 months [38]. ...
... Therefore, they cannot be compared. Some results are given in Table 1 [28,37,38,40]. ...
Article
Background: Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. Methods: This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration<3months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC). Results: Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS≥3 at 3 months (AUC=0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index≥30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. Conclusion: The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other.
... Therefore, it was not necessary to eliminate any of the items from the OMPSQ-H version. The percentage of the variance was a little higher than the original English version [17] but closely approximate with both ALBPSQ and Modified OMSQ version [17,38]. Additionally, the percentage of variance was comparable to the Spanish and Dutch version of OMPSQ [27,28], however, Grotle et al. [29] initially reported three components factor on the Norwegian OMSPQ, but Gabel et al. [38] stated that the reanalyzed data of the work reveals six components factor. ...
... The percentage of the variance was a little higher than the original English version [17] but closely approximate with both ALBPSQ and Modified OMSQ version [17,38]. Additionally, the percentage of variance was comparable to the Spanish and Dutch version of OMPSQ [27,28], however, Grotle et al. [29] initially reported three components factor on the Norwegian OMSPQ, but Gabel et al. [38] stated that the reanalyzed data of the work reveals six components factor. ...
Article
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Objectives Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) is widely used in clinical practice and for research purpose to screen the risk of chronicity in patients with Non-specific low back pain (NSLBP). The questionnaire has been cross-culturally adapted into different languages, but to date, there has not been Hausa version of the questionnaire. This study is important as the Hausa language is widely spoken across sub-Saharan Africa. The study aims to cross-culturally translate the English version of the (OMPSQ) into Hausa language (OMPSQ-H) and to test its psychometric properties in Hausa patients with NSLBP. Methods This observational study involved the use of forward-backwards translation method for the English version of OMPSQ. Thus, 124 male and female participants with subacute NSLBP were recruited using convenient sampling techniques. The psychometric properties statistically tested included reliability, internal-consistency, ceiling and floor effects, acceptability and construct validity. Results The Hausa version of OMPSQ has demonstrated good reliability (ICC=0.82) and internal consistency (Cronbach’s alpha=0.72) with good acceptability as all questions were answered in 5 min. Responsiveness was adequate as OMPSQ-H retest scores demonstrated good correlation with the global rating of change scale scores ( r =0.67, p=0.01). Construct validity was evaluated using principal component analysis and it reveals six components structure for the OMPSQ-H. Conclusions The OMPSQ-H was successfully translated and cross-culturally adapted with no problem of comprehension. Moreover, it has shown adequate psychometric properties in terms of internal consistency, reliability, responsiveness and constructs validity. Consequently, the OMPSQ-H can be considered as a valid tool for identifying and screening both psychosocial risk factors and risk of chronicity of NSLBP in Hausa population.
... The € Orebro Musculoskeletal Screening Questionnaire-12 ( € OMSQ-12) is a multidimensional and practical questionnaire assessing general musculoskeletal problems [12,13] and determining the risk of absenteeism in individuals with a musculoskeletal problems [14]. The ( € OMSQ-12) was adapted from the € OMSQ-21 [12,15] which was developed by a multi-stage reduction process from the original Acute LBP screening questionnaire (ALPBSQ) [16]. The ALBPSQ was subsequently adapted through simple language modification to become the € Orebro Musculoskeletal Screening Pain Questionnaire ( € OMPSQ) [17] however this was validated for workers, with pain, in the low back region; where as the € OMSQ and € OMSQ-12 were developed and validated for all individuals workers or not, with any problem, not just pain, and for any region, not just the low back. ...
Article
Purpose: The 12-item Örebro Musculoskeletal Screening Questionnaire (ÖMSQ-12) is a multidimensional questionnaire assessing general musculoskeletal problems. This study aimed to investigate its construct validity and reliability. Materials and methods: Confirmatory factor analysis (CFA) was performed for construct validity. The Tampa Scale for Kinesiophobia (TSK) and the SF-12 and Pain Numerical Rating Scale (P-NRS) were used for convergent validity. Reliability (ICC), internal consistency (Cronbach's alpha), reproducibility, and known-group validity were assessed. The cut-off value was measured. Results: A total of n = 378 individuals (aged 35.7 ± 12.4 years, female = 73.3%) with a musculoskeletal problem participated in the study. P-NRS score of the individuals was 5. Results showed that a 3-factor model did fit well under CFA (χ2/df = 2.76 ≤ 3). The questionnaire had good reliability (ICC = 0.865) and internal consistency (α = 0.810). There were no floor or ceiling effects (<%15). Total ÖMSQ-12-TR scores had a correlation with the TSK, SF-12 and P-NRS (r = 0.303-0.609). The AUC for the risk of absenteeism from work was obtained as 0.738 (p < 0.001). The risk of absenteeism was high in individuals with an ÖMSQ-12-TR score of ≥57.5. Conclusions: The ÖMSQ-12-TR is a valid and reliable questionnaire that can be used in determining the risk of absenteeism in musculoskeletal disorders and is convenient for online use. Clinical trial number: NCT04723615.
... The ÖMPSQ can also be used to identify LBP patients at risk for chronicity and prolonged disability, therefore a score of <90 indicates low risk, a score of 90-105 moderate risk, and a score of >105 high risks [48]. Gabel et al. [49] reported that the ÖMPSQ has high reliability (0.975) and was strongly correlated with recovery time (Spearman's r=0.71). Also, Ahmed et al. [50] reported that the Hausa version of the ÖMPSQ, which was used in this study, has adequate psychometric properties which are equivalent to these of the English version (reliability r=0.80, internal consistency α=0.72). ...
Article
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Objectives: Low back pain is the most prevalent musculoskeletal condition, and causes activity limitations which result in reduced work productivity and high medical expenditure. The management of this condition has been challenging to both clinicians and researchers. While the use of Muscle Energy Technique (MET) as a potentially effective treatment strategy seems promising, studies examining MET combined with exercise therapy are scarce and studies with a strong methodology are lacking. Therefore, this study aims to determine the effects of a combination of Dynamic Stabilization Exercises (DSE) and MET on selected biopsychosocial outcomes compared to DSE alone or conventional physiotherapy in the management of chronic non-specific low back pain (NSLBP). Methods: A total of 125 (80 male and 45 female) patients with chronic NSLBP were involved in this study, they were recruited from Rasheed Shekoni Teaching hospital and Federal Medical Centre Birnin-Kudu, Jigawa State, Nigeria. A random number generator method was used to allocate patients to either DSE + MET (n=41), DSE alone (n=39) or conventional physiotherapy (n=45). Interventions were administered twice a week over 12 weeks. Outcome measures included pain intensity, lumbar (flexion and extension) range of motion, functional-disability, self-perceived health status, limitations in activities and participation restrictions. These were assessed at baseline, mid intervention at six weeks, post-intervention at 12 weeks and long term follow-up at 24 weeks. Data was analyzed using repeated-measures ANOVA to determine the significant difference within groups and between groups. Results: All intervention groups showed within-groups changes in the study outcomes over time (p<0.001). However, between-group comparisons showed greater improvements in pain intensity (F=7.91, p<0.001), lumbar ROM (flexion F=1.51, p<0.001; extension F=3.25, p<0.001), activity limitations/participation restrictions (F=3.7, p<0.001) and health status (F=10.9, p<0.001) for the intervention in which MET and DSE were combined. The MET plus DSE interventions were superior to DSE and convention physiotherapy for all outcome measures, except for functional disability (F=0.53, p=0.590). Conclusions: The data from this study showed MET combined with DSE had greater therapeutic benefits compared to DSE or conventional physiotherapy on selected biopsychosocial outcomes in patients with chronic NSLBP. The findings from the study show that the combination of MET with DSE is safe and has beneficial effects in the management of patients with chronic NSLBP.
... The OMPSQ is a self-reported questionnaire consisting of 25 items (of which 21 are scored) which are built around five proposed constructs [59,60]: function, pain, psychological, fear-avoidance and miscellaneous. The construct consists of items involving pain location (item 4), work absence due to pain (item 5), pain duration (item 6), pain intensity (items 8 and 9), control over pain (item 11), frequency of pain episodes (item 10), functional ability (items 20 to 24), mood (items 12 and 13), perceptions of work (items 7 and 16), participants' estimate of prognosis (items 14 and 15), and fearavoidance (items 17 to 19) [59,61]. The scored items are summed to provide a total score potentially ranging from 0 to 210; the points are used to indicate low (90-100) and high (105-119) risk of prolonged recovery from LBP, with higher scores indicating a higher risk of poor outcome [60,62]. ...
... The OMPSQ is a self-reported questionnaire consisting of 25 items (of which 21 are scored) which are built around five proposed constructs [59,60]: function, pain, psychological, fear-avoidance and miscellaneous. The construct consists of items involving pain location (item 4), work absence due to pain (item 5), pain duration (item 6), pain intensity (items 8 and 9), control over pain (item 11), frequency of pain episodes (item 10), functional ability (items 20 to 24), mood (items 12 and 13), perceptions of work (items 7 and 16), participants' estimate of prognosis (items 14 and 15), and fearavoidance (items 17 to 19) [59,61]. The scored items are summed to provide a total score potentially ranging from 0 to 210; the points are used to indicate low (90-100) and high (105-119) risk of prolonged recovery from LBP, with higher scores indicating a higher risk of poor outcome [60,62]. ...
Article
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Background: Non-specific low back pain (NSLBP) is a common musculoskeletal condition causing functional disability and affecting the quality of life. Exercise therapy especially Dynamic Stabilisation Exercises (DSE) and Muscle Energy Techniques (MET) are frequently used in the treatment of NSLBP. However there are some inconsistencies with the use of DSE and the physiological mechanisms underlying the therapeutic effects of MET are currently unclear, and a review of literature on these interventions recommend further research. Therefore this study was designed to determine the effect of DSE and MET for the management of patients with NSLBP. Methods: This study will involve 141 participants with chronic NSLBP. They will be randomised into three groups: two intervention groups i.e. DSE plus MET group, DSE alone and control (standard physiotherapy treatment). Outcomes that include trunk range of motion, Transverse Abdominus contraction rate, trunk muscles endurance, level of pain perception, quality of life, functional disability, activity limitation and participation restrictions will be assessed at baseline, 6th and 12th week of intervention, however, while follow-up assessment at 3-months after the intervention. Data will be analysed using descriptive statistics and inferential statistics of repeated ANOVA; P < 0.05. Discussion: The study outcome will determine the combined effect of DSE plus MET on trunk muscles functions, level of pain perception, quality of life, functional disability, activity limitations and participation restrictions in patients with chronic NSLBP. Trial Registration: www.ClinicalTrials.gov: NCT03449810
... The STarT Back Screening Tool (SBST) was developed and validated to identify subgroups of patients with chronic LBP and to guide the initial decision making in primary care by physiotherapists 33 . The tool has comparable clinimetric properties to OMPSQ, which is the current reference standard screening tool 34 . The SBST is based on the presence of potentially modifiable physical and psychological indicators for persistent, disabling symptoms, identified through nine questions. ...
Article
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Objectives: This study identified disability sub-groups of patients with chronic Low-Back pain (LBP) using Subgroup for Targeted Treatment Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the view to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods: This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopaedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction was carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to –stand, 3600 roll test, Sorenson fatigue test, unloaded reach test, and 50 feet walk test). Pain intensity was assessed using quadruple visual analogue scale. Information on age, sex, height, weight and BMI were also obtained. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results: The mean age, weight, height and body mass index of the participants was 51.4±8.78 years, 1.61±0.76 m and 26.6±3.18 Kg/m2 respectively. The mean pain intensity and duration was 5.37±1.37 and 21.2±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. While, SBST sub-grouped majority of the participants as having medium disability risk (76%), SPPTB, sub-grouped the participants as having high disability risk (71.4%). There was significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT had floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’ which were the lowest and highest obtainable scores. The ‘Area Under Curve’ for the sensitivity (0.83) and specificity (0.23) of the SBST to predictive ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST was 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion: StartBack screening tool is more able to identify proportion of patients with low-back pain with moderate disability risks, while Simmonds physical performance tests battery is more able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance-based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. Converse to SPBBT, SBST has no floor and ceiling effects, and it has high sensitivity but low specificity to predict ‘high-disability risk’.
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Despite the widespread use of exploratory factor analysis in psychological research, researchers often make questionable decisions when conducting these analyses. This article reviews the major design and analytical decisions that must be made when conducting a factor analysis and notes that each of these decisions has important consequences for the obtained results. Recommendations that have been made in the methodological literature are discussed. Analyses of 3 existing empirical data sets are used to illustrate how questionable decisions in conducting factor analyses can yield problematic results. The article presents a survey of 2 prominent journals that suggests that researchers routinely conduct analyses using such questionable methods. The implications of these practices for psychological research are discussed, and the reasons for current practices are reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Given the proliferation of factor analysis applications in the literature, the present article examines the use of factor analysis in current published research across four psychological journals. Notwithstanding ease of analysis due to computers, the appropriate use of factor analysis requires a series of thoughtful researcher judgments. These judgments directly affect results and interpretations. The authors examine across studies (a) the decisions made while conducting exploratory factor analyses (N = 60) and (b) the information reported from the analyses. In doing so, they present a review of the current status of factor analytic practice, including comment on common errors in use and reporting. Recommendations are proffered for future practice as regards analytic decisions and reporting in empirical research.
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ABSTRACT: Purpose: To develop a conceptual model for patients with musculoskeletal injuries that relates Injury Screening to Measurement and Monitoring (ISMAM). Screening scores would predict quantifiable outcomes on a proposed Global Assessment of Body And Limbs (GABAL) composite scale. The scale would define status as a percentage of pre-injury capacity using quantitative and qualitative self report outcome measures combined with work and life status data. Background: Screening questionnaires use psychosocial yellow flags and activity limitation to identify potential chronic patients. Outcome measures provide clinical evidence by establishing patient status and assessing intervening change. Independently developed, definitive statistical links between these established concepts are yet to be determined. Description: The ISMAM components are integrated using a graph of time versus score on the GABAL-scale with initial screening predicting recovery time to a designated pre-injury percentage level. Actual status would be assessed through initial then subsequent sequential measurements with GABAL-scale scores enabling trendline analysis to verify if the rate of actual recovery coincides with that predicted by screening. Observations: Face and content validity are apparent because validated screening tools are available and the required components for the GABAL-scale would be existing validated outcome measures and quantifiable data. Conclusions: This model should provide a practical method of integrating screening and global measurement that facilitates communication across agencies and professions. A clinical research trial to validate the ISMAM concept has been initiated. KEY WORDS: EVIDENCE BASED PRACTICE, OUTCOME MEASURES, MUSCULOSKELETAL, ASSESSMENT.
Article
Most spine patient-reported outcome measures are divided into neck and back subregions. This prevents their use in the assessment of the whole spine. By contrast, whole-spine patient-reported outcome measures assess the spine from cervical to lumbar as a single kinetic chain. However, existing whole-spine patient-reported outcomes have been critiqued for clinimetric limitations, including concerns with practicality. To develop the Spine Functional Index (SFI) as a new whole-spine patient-reported outcome measure that addressed the limitations of existing whole-spine questionnaires; and to determine the SFI's clinimetric and practical characteristics concurrently with a recognized criterion, the Functional Rating Index (FRI). Observational cohort study within 10 physical therapy outpatient clinics. Spine-injured patients were recruited from a convenience sample referred by a medical practitioner to physical therapy. A pilot study (n=52, 57% female, age 47.6±17.5 years) followed by the main study (n=203, 48% female, age 41.0±17.8 years) that had an average symptom duration of less than 5 weeks. Spine Functional Index, FRI, and Numerical Rating Scale (NRS). The SFI was developed through three stages: 1) item generation, 2) item reduction with an expert panel and patient focus group, and 3) pilot field testing to provide provisional clinimetric properties and sample size requirements and to determine suitability for a larger study. Participants completed the SFI, FRI, and NRS every 2 weeks for 6 weeks, then every 4 weeks until discharge or study completion at 6 months. Responses were assessed to provide individual psychometric and practical characteristics for both patient-reported outcomes, with the overall performance evaluated by the Measurement of Outcome Measures and Bot clinimetric assessment scales. The SFI demonstrated a high criterion validity with the FRI (Pearson r=0.87, 95% confidence interval [CI]), equivalent internal consistency (α=0.91), and a single-factor structure. The SFI and FRI demonstrated suitable reliability (intraclass correlation coefficient2,1=0.97:0.95), responsiveness (standardized response mean=1.81:1.68), minimal detectable change with 90% CI (6.4%:9.7%), Flesch scale reading ease (64%:47%), and user errors (1.5%:5.3%). The clinimetric performance was higher for the SFI on the Measurement of Outcome Measures (96%:64%) and on the Bot scale (100%:75%). The SFI demonstrated sound clinimetric properties with lower response errors, efficient completion and scoring, and improved responsiveness and overall clinimetric performance compared with the FRI. These results indicated that the SFI was suitable for functional outcome measurement of the whole spine in both the research and clinical settings.
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Electronic computers facilitate greatly carrying out factor analysis. Computers will help in solving the communality problem and the question of the number of factors as well as the question of arbitrary factoring and the problem of rotation. "Cloacal short-cuts will not be necessary and the powerful methods of Guttman will be feasible." A library of programs essential for factor analysis is described, and the use of medium sized computers as the IBM 650 deprecated for factor analysis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)