Quebec Back Pain Disability Scale

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Objective

The Quebec back pain disability scale (QBPDS) is a condition-specific questionnaire developed to measure the level of functional disability for patients with low back pain (LBP) that was designed, developed and validated by Kopec et al in 1995. [1]
Original versions of the scale were developed in French and English and were reported to meet the most stringent criteria for a health assessment instrument. Investigators and qualified colleagues translated the English version of the QBPDS into Dutch, Iranian, Brazilian Portuguese, Turkish, Chinese, Greek, Polish, Korean and Arabic. [3][8]

The originally purpose of the questionnaire is to take into account the functional limitations related to pain, to monitor the progress of individual patients and to compare the evolution of LBP subjects incorporated in rehabilitation programs. [2][3][10]

The Quebec back pain disability scale consists of 20 daily activities that can be categorized into 6 types of activities: [1] [3]
Bed/rest items 1–3
Sitting/standing items 4–6
Ambulation items 7–9
Movement items 10–12
Bending/stooping items 13–16
Handling of large/heavy objects items 17–20.
The various components of the questionnaire were selected from a larger pool of items based on test-retest reliability, item-total correlations, and responsiveness of individual items and by using techniques of factor analysis and item response theory. [1]

The scale exists of one central question: “Do you have trouble today with...?” followed by 20 activities of daily life. Some examples of daily activity: taking something out of the fridge, getting out of bed... In every activity, there are 6 answer categories, measured by using a Likert scale from 0-5 (0 = no effort, 5 = not able to). If the patient suffers a lot that day, he scores that activity with a 5, if it gives no problems a 0. [1][2][8] The final outcome is obtained by the sum of the scoring of the degree of difficulty in performing the 20 daily activities. These outcomes score within the range of 0 and 100, determents the level of functional disability, with higher numbers representing greater levels of disability. [1] [8]

Intended Population

The Quebec back pain disability scale has been developed for several populations of patients with various disability levels who suffer diseases such as acute LBP, chronic disabling pain, sacroiliac joint dysfunction, lumbar spinal stenosis, disc surgery, and posterior surgical decompression and settings. ((level of evidence: 2 ) [3]

The QBPDS is a useful instrument when someone wants to get an overall impression on the improvement in Pelvic girdle pain. (level of evidence: 2B ) [6]

Method of Use

Patients are asked to answer the QBPDS according to the difficulty they have to perform the activities the current day. The QBPDS examines how the lower back pain affects your daily life. It is very important that the patient gives a score for every activity; it is not allowed to skip an activity. (level of evidence: 2A) [3]

The scoring is done by count every digit, circled by the patient. The end score will be between 0 (no limitation) and 100 (totally limited). [2] [3]

It is a very easy questionnaire and takes only five minutes. The QBPDS can be completed by patients by using paper and pen, mail or telephone. [2]

Reference

 R. Smeets et al. Measures of Function in Low Back Pain/Disorders. Arthritis Care & Research 2011; 63: 158–173 (level of evidence: 2A)[3]
 J.M. Fritz, J. J Irrgang. A Comparison of a Modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy 2001; 81: 776-788. (level of evidence: 2B)[1]

Evidence

Responsiveness

The responsiveness of the QBPDS is similar to the responsiveness of the Roland-Morris disability questionnaire, modified Oswestry disability questionnaire, Waddell disability index and the physical function subscale of SF-36. (Grade of recommendation: C) [4]

The QBPDS is highly sensitive to change for the score of the individual domains as for the total score (SRM= 0,80 and effect size= 0,62). [5] In addition, the scale is able to recognize small changes in level of disability over time. (Grade of recommendation: B) [3] Davidson and Keating found a minimal detectable change of 19 (95% CI 14-24) at patients with low back pain who reported no change during six weeks. For patients with chronic low back pain is the minimal detectable change 15,8. (Grade of recommendation: B) [3]

The area under the curve (AUC) can be used as a quantitative method to differ patients who improved or deteriorated from the patients who stayed stable. [1] The AUC for the detection of change in patients with chronic low back pain is 0,856. This means that in 85,60 % of the cases the test correctly recognize a change in chronic low back pain. (Grade of recommendation: B) [3]

Miscellaneous

The patients and the clinicians both accept the use of the QBPDS. Researchers (Kopec et al.) declare a low item default (range 0,7-1,8%) [7]. Questionnaires sent by mail had a higher rate of incomplete questionnaires (10.8%). Some patients remarked that a couple of items were not precise enough and the choice between score 0 and 1 and between 4 and 5 wasn’t always convenient. The researchers didn’t found ceiling or floor effects in the answers. (Grade of recommendation: B) [3]

References

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