Brief Report
Self-reported disability according to the International Classification of Functioning, Disability and Health Low Back Pain Core Set: Test-retest agreement and reliability

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Abstract

Background

The International Classification of Functioning, Disability and Health (ICF) Low Back Pain Core Set (LBP-CS) has been proposed as a tool to facilitate the description and measurement of chronic low back pain (CLBP) related disability. Patient ratings of ICF categories may serve as a practical and effective method for acquiring patient input on activity limitations and participation restrictions.

Objective

To investigate the test-retest agreement and reliability of patient ratings of activity and participation according to the LBP-CS.

Methods

A cross-sectional repeated-measures questionnaire study was undertaken with thirty-one medically stable adults with CLBP who presented for treatment at two public Australian hospitals. Participants completed the LBP-CS Self-Report Checklist (LBP-CS-SRC) on two occasions (mean = 12.5 (SD = 4.5) days between administrations). The LBP-CS-SRC permits patients to self-rate their functioning according to the LBP-CS activity and participation categories and enables the derivation of activity limitation and participation restriction scales.

Results

Patient ratings of individual LBP-CS categories generally exhibited good – excellent test-retest agreement (percentage exact agreement: 74.19–100.00%) and reliability (kappa: 0.53–1.00). The test-retest reliability coefficients of the LBP-CS-SRC activity (ICC = 0.94) and participation (ICC = 0.90) scales were excellent. The minimum detectable change values for the activity and participation scales were 8.11 and 15.26, respectively.

Conclusions

This study is the first to demonstrate that patients can provide reliable ratings of functioning using the LBP-CS. The LBP-CS-SRC was shown to be acceptably reliable and precise to support understanding of patients' perspectives on disability in rehabilitation practice and research.

Section snippets

Design, participants, and setting

A cross-sectional repeated measures questionnaire study was undertaken with a sample of outpatients attending a multidisciplinary service that provided conservative rehabilitative management of chronic musculoskeletal conditions at two public hospitals in Brisbane, Australia. As part of routine practice, patients who were new to the service were mailed a letter notifying them of their initial appointment details. From June–December, 2013 a study invitation letter, informed consent form, and the

Results

Thirty-eight participants completed the LBP-CS-SRC at both time-points. Of these, seven were omitted from further analyses as they either commenced treatment in-between the two LBP-CS-SRC administrations or endorsed a response other than ‘no change’ on the patient global impression of change item at time 2. Participants' demographic and clinical characteristics are contained in Table 1.

The mean (SD) time between LBP-CS-SRC administrations was 12.5 (4.5) days. PEA and kappa ranged from 74.19 to

Discussion

To the investigators' knowledge, this is the first study to examine the test-retest reliability of self-reported disability according to the LBP-CS. Patient ratings of LBP-CS categories, via the LBP-CS-SRC, generally exhibited good to excellent test-retest agreement and reliability adjusted for concordance due to chance. The test-retest reliability of the LBP-CS-SRC activity and participation scales was excellent. LBP-CS-SRC activity and participation scale scores were temporally stable (i.e.,

Conclusion

The present study investigated the test-retest agreement and reliability of a new methodological approach for assessing self-reported disability according to the LBP-CS. The LBP-CS-SRC was shown to be acceptably reliable, precise and feasible for routine application in rehabilitation research and practice. Rehabilitation clinicians and researchers may consider using the LBP-CS-SRC to measure disability and improve understanding of patients' perspectives on activity limitations and participation

Funding

The Royal Brisbane and Women's Hospital Foundation and the Allied Health Professions' Office of Queensland provided support. SMM is supported by a National Health and Medical Research Council (#1090440) (of Australia) fellowship. These agencies did not provide input on any aspect of the study, decision to publish, manuscript preparation or submission.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author contributions

KB led the study conception and design, data collection and analysis, results interpretation, and manuscript drafting. JS provided input on the study design and interpretation of the results. PM assisted with results interpretation. SM contributed to the data analysis and results interpretation. The manuscript was critically reviewed and approved by each author.

Acknowledgement

The authors are grateful to the clinicians and, in particular, the administration officers and therapy assistants, for their assistance with data collection. The investigators appreciate the support provided by the Manager of each clinic (Darryl Lee and Louise Matthews) and the Program Manager for the statewide service (Maree Raymer). In addition, the investigators are thankful for input from Emeritus Professor Roland Sussex during the preliminary stages of this project.

References (36)

  • R. Hilfiker et al.

    The use of the comprehensive International Classification of Functioning, Disability and Health Core Set for low back pain in clinical practice: a reliability study

    Physiother Res Int

    (2009)
  • C. Roe et al.

    Low back pain in 17 countries, a Rasch analysis of the ICF core set for low back pain

    Int J Rehabil Res

    (2013)
  • T.H. Yen et al.

    Systematic review of ICF core set from 2001 to 2012

    Disabil Rehabil

    (2014)
  • C. Bostan et al.

    Investigating the dimension functioning from a condition-specific perspective and the qualifier scale of the International Classification of Functioning, Disability, and Health based on Rasch analyses

    Am J Phys Med Rehabil

    (2012)
  • K.S. Bagraith et al.

    Chapter 22. Rehabilitation and the world health organization's international classification of functioning disability and health

  • M. Kierkegaard et al.

    Perceived functioning and disability in adults with myotonic dystrophy type 1: a survey according to the International Classification of Functioning, Disability and Health

    J Rehabil Med

    (2009)
  • K.S. Bagraith et al.

    Rasch analysis supported the construct validity of self-report measures of activity and participation derived from patient ratings of the ICF low back pain core set

    J Clin Epidemiol

    (2016)
  • E. Grill et al.

    Criteria for validating comprehensive ICF Core Sets and developing brief ICF Core Set versions

    J Rehabil Med

    (2011)
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