Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 8 , Pages 637-638, October 2005

Response to Letter to the Editor by Bolton

Musculoskeletal Research Unit, Orthopedic Department, Lægaardvej 12 7500, Holstebro, Denmark

Research Professor, Back Research Center, Backcenter Funen and University of Southern Denmark, Denmark

Article Outline

 

In Response:

There is a multitude of questionnaires for patients with low back pain (LBP). It has been recommended1 that two well-tested instruments2, 3 be used in the future to allow comparison between studies and study populations.1

A new instrument, the 7-item Bournemouth Questionnaire (BQ), was developed, which appears promising in that it contains also a psychological dimension (lacking in the other two questionnaires) yet is shorter than the other two.4 However, the introduction of new questionnaires requires that these are better than the two already recommended.

Because the BQ might be a “better” questionnaire, we decided to take a closer look at it, specifically to find out if (1) all the 7 items in the BQ were relevant; (2) the responses to the BQ were similar to those of the Oswestry questionnaire; and (3) the BQ could predict treatment outcome.

We found that (1) anxiety and depression seemed to be largely irrelevant in our study population; (2) the same person could be categorized as very ill in one questionnaire and not that ill in the other; (3) the BQ used, as recommended, 5 as an index was not good at predicting outcomes.

We concluded that, “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.”

A letter to the editor brings forth the following points of disagreement:

1.We studied the BQ's predictive and not monitoring properties.Response: If an instrument is not related to outcomes, why should it be used?

2.BQ does add to the main two recommended questionnaires because it has robust psychometric properties comparable with other outcome measures, that it is shorter and more practical, that it can be used in the confidence that it measures a wide spectrum of outcomes, and that it is already used by many chiropractors.Response: In order to replace two already highly accepted outcome instruments this is not enough. You have to demonstrate that it is also better. Unfortunately, the results of our study did not support the latter.

3.The accuracy of our data is queried because there was no reference to any rigorous validity studies of the translated versions of the questionnaires into Norwegian.Response: The BQ was translated into Norwegian and retranslated into English in a less elaborated manner than recommended by Beaton et al6 However, the questions in the BQ are straightforward and there are no obvious cultural differences between Norway and England, so the questions should be easily translated and understood.

4.The BQ was never intended to be a diagnostic or predictive instrument. To test it as such is “unfair”.Response: Science is characterized by development. Therefore, one cannot prevent others to study the BQ from different angles. Whether this is “unfair” or not, surely, is irrelevant.

Our final conclusion is that until a questionnaire is proven to be better, it is better to follow the recommendations by Deyo et al1 to keep on using the Oswestry and Roland-Morris questionnaires to make the effect of LBP treatment comparable between patients and professions worldwide.

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References 

  1. Deyo RA, Battié M, Beurskens AJ, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research. A proposal for standardized use. Spine. 1998;23:2003–2013
  2. Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141–144
  3. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–273
  4. Bolton JE, Breen AC. The Bournemouth Questionnaire: a short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther. 1999;22:503–510
  5. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004;27:26–35
  6. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186–3191

PII: S0161-4754(05)00230-7

doi:10.1016/j.jmpt.2005.08.008

Refers to article:

  • The Bournemouth Questionnaire: Can it be Used to Monitor and Predict Treatment Outcome in Chiropractic Patients With Persistent Low Back Pain?

    Jennifer E. Bolton
    Journal of Manipulative and Physiological Therapeutics October 2005 (Vol. 28, Issue 8, Page 637)

Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 8 , Pages 637-638, October 2005

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