Biopsychosocial screening questionnaire for patients with low back pain: preliminary report of utility in physiotherapy practice in Northern Ireland. (University of Ulster, Jordanstown, Northern Ireland) Clin J Pain 2000;16:214–228.

Abstract

This study aimed to investigate the potential utility of a new biopsychosocial‐screening questionnaire by exploring the relationship between it and several physical risk factors and posttreatment outcomes. The relationship between the screening questionnaire and valid and reliable outcome measures of pain and functional disability was also compared. Significant associations were detected between questionnaire scores and pretreatment “leisure time exercise,”“analgesic medication use,” and “subjective anesthesia;” posttreatment “return to work;”and “number of physiotherapy treatments” as well as pain and functional disability measures. A cutoff “at risk” sore of 112 was calculated, which correctly classified 74% of the patients who received six treatments and 80% of the patients who failed to return to work at the end of the treatment. The findings of this study provide preliminary evidence of the utility of this biopsychosocial screening questionnaire for future use in clinical intervention studies in the Northern Ireland National Health Service. Further comparative investigations in other health care settings are warranted.Comment by Phillip S. Sizer Jr., MEd, P.T. The investigators presented a study aimed at evaluating the utility of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) in patients with LBP in the Northern Ireland NHS. A cut‐off score for the questionnaire was established by examining the relationship between the questionnaire and several documented risk factors, as well as validated treatment outcome measures for pain and functional disability. This cross‐sectional and longitudinal design was based on a thorough evaluation of the literature regarding risk factors for the development of LBP chronicity. A total of 118 patients (47 male, 71 female; mean age of 43.19 years) participated. The questionnaire was comprised of 24 items divided into the following groups: function, pain, psychological factors, fear avoidance, and miscellaneous (sick leave, age, gender, nationality, monotonous versus heavy work, and job satisfaction). Pain was measured with the McGill Pain Questionnaire (MPQ) and pain‐specific functional disability was measured with the Roland Morris Disability Questionnaire (RMDQ). These measures were conducted before and after treatment, which included advice, education, exercise, manipulative therapy, electrotherapy, traction and thermal agents. The ALBPSQ was significantly correlated with three pretreatment variables (leisure time exercise, subjective anesthesia, and analgesic medication) and two posttreatment variables (Return to work and number of physiotherapy treatments). Additionally, the investigators suggested an ALBPSQ cutoff score of 112, although they supported the idea that the screening tool is not 100% accurate. They also found that a score of 112 was significantly associated with the MPQ and RMDQ scores. Furthermore, they observed no significant differences in ALBPSQ scores from working versus nonworking individuals. The authors noted the limitations of this investigation, which included the lack of a control group, inconsistent treatment strategies, and the absence of evaluating the impact of litigation on score outcomes. With these limitations in mind, the ALBPSQ may prove to be a useful tool in both research and clinical practice for predicting risk for chronicity. Future research should include a similar investigation in the United States, considering potential differences in the two health care delivery systems, as well as respective patterns of managing worker's compensation.