Physical outcome measures of physical functioning systematic review
Physical functioning is important to measure effectiveness of treatments for low back pain. This systematic review identified questionnaires and tests (for example, muscle strength) that are used to measure physical functioning in people who have low back surgery. It also assessed the validity, reliability and responsiveness to change of the tests of physical functioning.
Project status: Complete
Physical functioning is important to measure effectiveness of treatments for low back pain, such as surgery. Questionnaires are commonly used, but physical functioning also requires evaluation with tests, such as muscle strength. Selecting tests that are valid, reliable and responsive to change is important to accurately measure effectiveness of treatments.
Stage 1 of this project identified questionnaires and tests used to evaluate physical functioning in low back surgery. 1,101 articles were included, identifying 137 questionnaires and 134 tests of physical functioning
Stage 2 evaluated the validity, reliability and responsiveness to change of the 134 tests identified in stage 1. 43 articles were included, identifying 34 tests with evaluations of validity, reliability or responsiveness. Moderate-level evidence supported responsiveness of the 1-min stair climb and 50-foot walk tests, and reliability of the 6-min walk test.
Many tests of physical functioning are used in low back surgery. Few have evidence of validity, reliability and responsiveness. Results highlight promise for a range of tests, but prospective, low risk of bias studies are required.
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 questionnaires and tests used to evaluate physical functioning and synthesize the literature on which tests of physical functioning are valid, reliable and responsive to change.
Findings
Stage 1: 1,101 articles were included, which identified:
- 137 questionnaires of physical functioning (70 established in the literature, 67 developed by study authors)
- 134 tests of physical functioning
Stage 2: 43 articles were included. Despite 134 tests identified in stage 1, only 34 had evaluations of validity, reliability and responsiveness to change. Moderate-level evidence supported:
- Responsiveness of the 1-minute stair climb and 50-foot walk tests
- Reliability of distance walked during the 6-minute walk test
- Insufficient responsiveness of the 5-minute walk test
Impact
There is promise for tests of physical functioning to demonstrate validity, reliability and responsiveness, but few clear recommendations can be made. This knowledge is essential to establish consensus on appropriate tests of physical functioning, evaluate effectiveness of interventions for low back surgery and inform clinical practice. Prospective low risk of bias studies are required owing to emerging evidence demonstrating the value of tests of physical functioning.
Key Publications
Kowalski K, Mistry J, Beilin A, Goodman M, Lukacs M, Rushton A. Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures. PLoS one. 2024. 19(8), e0307004.
Kowalski K, Lukacs M, 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.
