The Bournemouth Questionnaire: Can it Be Used to Monitor and Predict Treatment Outcome in Chiropractic Patients With Persistent Low Back Pain?
Received 4 November 2003; received in revised form 5 January 2004
Objective
To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP).
Study Design
Predictive and concurrent validation study.
Study Participants and Setting
One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year.
Methods
Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year.
Data Analysis
Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ.
Results
The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes.
Conclusions
The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes.
Sources of support: Funding was provided by the Research Council of Norway and the Swedish Chiropractic Association.
aResearcher, The Musculoskeletal Research Unit, Orthopedic Department, Denmark
bResearch Professor, The Back Research Center, Backcenter Funen and University of Southern Denmark, Denmark
Submit requests for reprints to: Kristian Larsen, PT, MPH, The Musculoskeletal Research Unit, Orthopedic Department, Lægaardvej 12 7500, Holstebro, Denmark.
Sources of support: Funding was provided by the Research Council of Norway and the Swedish Chiropractic Association.
ABSTRACT