There is a new trend to try and find out what patients want out of treatment — and more than just pain relief, though that would be good, too. Getting to the bottom of patients’ real priorities isn’t just a matter of asking them, What do you want?. There are pain limitations, functional limitations, social, and psychologic factors to consider.
Toward that end, some clinicians are using validated surveys to test patients in these various domains. And there are plenty of tests out there to assess people with chronic low back pain. Physicians, physical therapists, and other rehab counselors often use the Roland-Morris Disability Questionnaire, the Oswestry Disability Index (ODI), and the Quebec Back Pain Disability Questionnaire (QUEBEC) to look at disability and participation restrictions. They also use tools such as the Visual Analog Scale (VAS) and the Numerical Rating Scale (NRS) to measure pain intensity.
Another test called the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) looks at what the patient would like to do — what the patient cannot do because of pain. These are the issues that really matter to the patient. The MACTAR looks at mobility; community, social, and civic life; domestic life; work; interpersonal interactions and relationships; and self-care.
Each of those main sections has multiple subsections of activities and participation. For example, mobility looks at driving, walking, standing, running, climbing, and changing positions. Community/social/civic life includes sports, recreation, and leisure including crafts, hobbies, the arts, and culture. Domestic life ranges from shopping and doing housework to caring for plants or gardening, and preparing meals.
Other tests can measure coping skills, level of anxiety and depression, and any fear-avoidance behavior. Fear-avoidance refers to the concept that people in pain often stop moving in ways they think might cause it to hurt or cause another injury. The result of that behavior is more pain from the altered movement patterns or avoidance of movement.
There isn’t one test that can give a global picture of the patient’s needs, wants, or desires. It usually takes several to put together all of the information needed. Using a variety of tests helps give a valid measure of real-life participation limitations identified by the patient with chronic low back pain. That’s what it takes to get the kind of comprehensive information needed to make clinical decisions, establish treatment goals, and plan treatment.