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The Bournemouth Questionnaire

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Original Editor - Laura Bronckaerts

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Laura Bronckaerts  

Contents

Objective[1][2]

The Bournemouth questionnaire (BQ) is a short, self-report questionnaire, developed by J. Bolton.
The questionnaire exists in two different versions. The first version measures different dimensions in patients with low back pain, whereas the second one was developed to assess pain in patients suffering from non specific neck pain (The Neck Bournemouth Questionnaire).

A lot of questionnaires which concentrate on pain and disability in patients with low back pain and neck pain already existed. However, since other dimensions are also involved with musculoskeletal pain, the BQ was developed. The development was based on the dimensions of the ICF, which means that, next to the pain and disability, it also takes the affective and cognitive aspects of neck pain and low back pain in account.

Both versions of the questionnaire consist of seven core items, which are: pain intensity, function in activities of daily living, function in social activities, anxiety, depression levels, fear avoidance behavior and locus of control behavior. The only difference between the questionnaire for low back pain and the Neck BQ is the subscript in the item ‘activities of daily living’. The items “walking”, “climbing stairs” and “getting in/out of bed”, described in the Back BQ, where modified to “lifting”, “reading” and “driving” in the Neck BQ.

Intended Population

The questionnaire was developed for patients suffering from non specific low back pain or non specific neck pain.
Larsen and leboeuf (2005) indicated that the questionnaire is not useful in patients with persistent low back pain.[3]

Method of Use [2]

Both the questionnaires are used in the same way. Completing the test takes about 5 minutes.
The questionnaires exist of 7 questions which contain the different dimensions of the ICF.
Each item is rated on a numeric rating scale (NRS) from 0 to 10:
0= Much better
5= no change
10= much worse.
A total score on 70 can be calculated, in which a higher score reflects more complains.

Reference

Evidence

Reliability [1][4]

Homogeneity or internal consistency: It is important for a questionnaire that all the items measure different aspects of the disease; in order to enable computing a total score by summing up all items. The items should all correlate with each other and every item also needs to correlate with the total score.
A Chronbach’s α of 0.90 was found for both questionnaires, consequently the BQ can be considered a reliable instrument. Furthermore, this indicates that all of the items contribute to the total score.

Test-retest reliability can be tested by using the intra class correlation coefficient (ICC).
This coefficient compares scores on a test that was completed by a person at two different moments.
The ICC in the BQ for back pain patients approached 0,9 for the 3 moments (Pre-, posttreatment and retest), indicating a strong correlation between the total scores in the patients.
In the Neck BQ, the ICC amounted 0,65, which indicates a moderate agreement between total scores in these patients.

Validity [1][4]

An instrument is considered to be valid when it measures what it is supposed to measure.

- Content validity: Indicates in which degree a questionnaire covers the aspects of the measured attribute.[5]
- External construct validity: describes the degree in which a measure is related to other measures in a questionnaire. Each of the items can be compared to the items of another questionnaire or against the whole questionnaire. [5]

The BQ for low back pain
To determine the external construct validity, the BQ was tested against:
- Chronic Pain Questionnaire(CPQ)
- Revised Oswestry Disability Questionnaire (RODQ)
- Modified Somatic Pain Questionnaire (MSPQ)
- Fear Avoidance Beliefs Questionnaire (FABQ)
- Pain Locus of Control questionnaire (PLC) 

Correlation of BQ with  CPQ RODQ PLC MSPQ FABQ
Pearson’s r  0,77  0,78 0,40  0,36

0,32

The seven items where compared to the CPQ, MSPQ, RODQ, FABQ,zung and PLC.
The comparisation showed a correlation between 0,24 and 0,79. All items showed a significant correlation with their counterpart measure, which means that the test can be considered valid.

The Neck BQ
To determine the external construct validity, the BQ was tested against the CNFDS and the NDI:

NDI CNFDS
Pretreatment:  0,51

 0,63

Posttreatment:  0,71  0,48

The seven items where compared to the NFDS, SF36 and NDI. With a pretreatment correlation between 0,37 - 0,62 and a posttreatment correlation between 0,44 and 0,83.
All items showed a good correlation with their counterpart measure.

Responsiveness

The responsiveness or sensitivity is the ability of a questionnaire to detect clinically important changes over time.

The sensitivity to change can be measured by the ‘Standardized response mean’ (SRM). The SRM calculates the relative magnitude of the mean change compared to the variability of the changes.
A higher SRM indicates a greater sensitivity to change, SRM under the level of 0,5 indicates no sensitivity to change.       The Neck BQ showed a SRM of 1,17,which means that the questionnaire had a good sensitivity to changes.[6]
The SRM of the BQ for low back pain was 0,78, which means that this questionnaire is less sensitive to changes than the Neck BQ, but can still find significant changes of treatment.[7]

Internal longitudinal construct validity: Internal responsiveness of individual items of the questionnaire. The correlation should be 0,3 or higher to make sure that each item contributes significantly to the total responsiveness of the test.

In the BQ for low back pain all of the 7 items showed a correlation greater than 0,56. In the Neck BQ all of the items obtained a correlation greater than 0,42.[1] [4]
This indicates that all the items where significant, which means that each item is individually responsive to clinical significant changes. Furthermore, each item contributes significantly to the change in the total score.

Bolton et al (2004) indicated that an improvement of 13 points on the total score or a percentage change score of 36% was associated with clinically significant improvement. [6]

Miscellaneous

Links

View the Neck Bournemouth Questionnaire

View the Bournemouth Questionnaire for low back pain

Recent Related Research (from Pubmed)

References

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  1. 1.0 1.1 1.2 1.3 Bolton J., Humphreys B., The Bournemouth Questionnaire: a short form comprehensive outcome measure. II. Psychometric properties in neck pain patients. Journal of manupilative andphysiological therapeutics, 2002.(A2)
  2. 2.0 2.1 Gay R., Madson T., Cieslak K., Comparison of the neck disability index and the neck Bournemouth questionnaire in a sample of patients with chronic uncomplicated neck pain. Journal of manipulative and physiological therapies, 2007.(B)
  3. Larsen K., Leboeuf C., The Bournemouth Questionnaire, Can it be used to monitor and predict treatment outcome in chiropractic patients with persistent low back pain? Journal of manipulative and physiological therapeutics,2005.(A2)
  4. 4.0 4.1 4.2 Bolton J., Humphreys B., The Bournemouth Questionnaire: a short form comprehensive outcome measure. I. Psychometric properties in back pain patients. Journal of manupilative andphysiological therapeutics, 1999.(A2)
  5. 5.0 5.1 Liebenson G., Rehabilitation of the spine, Williams and Wilkins, 1996
  6. 6.0 6.1 Bolton J., Sensitivity and specificity of outcome measures in patients witch neck pain: Detecting clinically significant improvement. Spine, 2004.(C)
  7. Perillo M., Bulbulian R., Responsiveness of the Bournemouth Questionnaire and Oswestry Questionnaire: A prospective pilot study. Journal of manipulative and psychological therapeutics, 2003.(C)

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