Physical outcome measures of physical functioning systematic review
Physical functioning is important to measure effectiveness of treatments for low back pain. This systematic review will identify questionnaires and physical measures (for example, muscle strength) that are used to measure physical functioning in people who have low back surgery. It will also assess the validity, reliability and responsiveness to change of physical measures of physical functioning.
Project status: In progress
Physical functioning is a key area to measure effectiveness of treatments for low back pain, such as surgery. Questionnaires are commonly used to, but they are not comprehensive. In contrast, physical measures can assess multiple aspects, including impairments (for example, strength), performance on a standardized task (for example, walking tests) and activity in a natural environment (for example, daily steps). Selecting physical functioning measures with adequate validity, reliability and responsiveness to change is important to accurately measuring effectiveness of treatments for low back pain.
However, no comprehensive resources exist that detail all questionnaires and physical measures that can be used to assess physical functioning or that combines results from research on validity, reliability and responsiveness of the physical measures in low back surgery.
Stage one of this systematic review will identify questionnaires and physical measures used to evaluate physical functioning in the low back surgery population. Stage two will assess the validity, reliability, responsiveness of the physical measures. Two researchers will independently determine eligibility of studies to be included in the review, extract data, assess risk of bias and determine quality of evidence.
Results will enable selection of best available physical measures of physical functioning to measure effectiveness of treatments and inform decisions about the need for rehabilitation in low back surgery.
CANSpine Researchers
Katie Kowalski
Jai Mistry
Anthony Beilin
Michael Lukacs
Alison Rushton
Collaborators
Maren Goodman
Purpose
The purpose of this research is to generate a comprehensive resource of physical functioning outcome measures and synthesize the literature on the measurement properties (validity, reliability, responsiveness) of physical outcome measures of physical functioning.
Findings
This systematic review is in progress. Early results from stage one (1,101 included articles) indicate most research uses patient reported outcome measures to assess physical functioning (88%). A diverse range of physical measures are used (74 physical outcome measures identified). However, early results from stage two (38 included articles) revealed few investigations of measurement properties. There was moderate level evidence for sufficient responsiveness of stair climb and 50ft walk tests, and insufficient responsiveness of a 5min walk test. There was very low to low level evidence of sufficient reliability and indeterminant measurement error, validity and responsiveness of a wide range of physical measures across domains of impairments, performance on a standardized task and activity in a natural environment. Low risk of bias studies are required for definitive recommendations to evaluate physical functioning using physical measures in low back surgery.
Impact
The comprehensive resource of physical functioning outcome measures can inform decision-making in low back pain care pathways and enable targeted rehabilitation interventions. Synthesis of measurement properties aids in selecting the best available physical outcome measures. Several research gaps were identified, such as many physical outcome measures being used but not all validated for use.
Key Publications
Kowalski KL, Lukacs MJ, Mistry J, Goodman M, Rushton A. Physical functioning outcome measures in the lumbar spinal surgery population and measurement properties of the physical outcome measures: protocol for a systematic review. BMJ open. 2022 Jun 1;12(6):e060950.
