Information concerning a patient's functional status is often obtained by asking the patient about activities that cannot be assessed directly in the clinical setting. This information is usually acquired through a verbal exchange between the clinician and patient. The measurement properties of the verbal exchange are unknown. An alternate method of obtaining this information is when patients self-report their functional status. The measurement properties of self-report questionnaires are well known; however, these measures are used infrequently for the evaluation of functional status, progress, and outcome in the clinic. Two reasons are possible for the infrequent use of self-report questionnaires: (1) values obtained from self-report measures have not been used to guide the care of the patient, and (2) a perception exists that these measures take a great deal of time to administer and score. The purpose of this clinical commentary was to describe the application, scoring, and use of a functional status measure (the Roland-Morris Questionnaire) for persons with low back pain and to illustrate how this questionnaire can be efficiently incorporated into clinical practice to aid decision making concerning individual patients. Three patient scenarios are used to illustrate the issues raised in this paper.

J Orthop Sports Phys Ther. 1999;29(4):232-239.

Key Words: low back pain, disability, measurement

Study Design: Single group repeated measures with multiple raters. Objectives: To determine the interrater reliability of KT-1000 measurements of novice and experienced raters and to provide error estimates for these raters. Background: The KT-1000 arthrometer is often used clinically to quantify anterior tibial displacement. Few data have been documented, however, about the relative reliability of KT-1000 measurements obtained by novice compared with experienced users. Methods and Measures: Two novice and two experienced KT-1000 users performed measurements on 29 knees of 25 patients after anterior cruciate ligament (ACL) reconstruction or with a diagnosis of ACL deficiency. Measurements were performed at 131 N. Interrater and intertrial reliability coefficients (interclass correlation coefficient; ICC) and the standard error of measurement were calculated for expert and novice raters. Results: The interrater ICC for novices was 0.65 and the interrater error was ±3.52 mm (90% confidence interval [CI]). The interrater ICC for experts was 0.79 and the interrater error was ±2.94 mm (90% CI). Conclusions: These results suggest that experience in using the KT-1000 is related to the interrater error of measurements and that training is an important consideration when using the KT-1000 arthrometer.

J Orthop Sports Phys Ther. 1999;29(1):49-55.

Key Words: Standard error of measurement, reliability, testing

Self-report measures of disability are being used more frequently to assess patients' outcomes in clinical practice. This study examines the reliability, validity, and sensitivity to change of the Patient-Specific Functional Scale when applied to persons with neck dysfunction. The Patient-Specific Functional Scale and Neck Disability Index were applied at the initial visit, within 72 hours of the initial visit, and following 1-4 weeks of treatment in 31 patients with cervical dysfunction. At the time of the initial visit, the clinician made an estimate of patients' prognoses on a 5-point scale. This estimate served as an a priori construct for change: patients with better ratings would change more. The results demonstrate excellent reliability (R = .92), validity (r = .73-.83 compared with the Neck Disability Index, and r = .52-.64 compared with the prognosis rating), and sensitivity to change (r = .79-.83 compared with Neck Disability Index change scores, and r = .46-.53 compared with the prognosis rating). No difference was found between the Patient-Specific Functional Scale and Neck Disability Index in their ability to detect change over time. The results of this study are consistent with previous investigations, which have concluded that the Patient-Specific Functional Scale is an efficient and valid measure for assessing disability and change in disability in persons with low back pain and knee dysfunction.

J Orthop Sports Phys Ther. 1998;27(5):331-338.

Key Words: functional status, clinical outcome, measurement

Clinicians frequently use the results of clinical diagnostic tests to make decisions concerning patients. The intent of this paper is to review the technical aspects and measurement properties of the McMurray test and, more globally, to illustrate the impact that indiscriminate test application has on test interpretation. The literature shows that diagnostic accuracy studies, which evaluate the test described by McMurray, yield remarkably similar estimates of sensitivity (about 26%) and specificity (about 94%). These test characteristics are applied to 3 case scenarios to illustrate the impact that history-specific prevalence (ie, the likelihood a patient has the condition based on the history) has on the predictive values. The results show a high false positive rate when applied to patients who, based on the history, have a low pre-physical examination likelihood for the condition of interest and a higher false negative rate when applied to patients who have a high history-specific prevalence. Readers are warned that the exhaustive examination approach effectively lowers the prevalence and results in a high false positive rate. The impact that the exhaustive approach has on increasing the false positive rate is universal to all diagnostic investigations and is not unique to the McMurray test.

J Orthop Sports Phys Ther. 1995;22(3):116-120.

Key Words: diagnosis, knee, McMurray test

Studies are needed to enhance our understanding of functional outcomes. The purpose of this paper is to describe a community clinic program for injured workers with low back pain and to report outcomes of the first 50 consecutive patients to enter the program who were evaluated using a standardized assessment procedure. Data for this report were collected from a retrospective chart review as part of an evaluation of the program. The patients referred to the clinic entered a 4-week treatment program. They were assessed at entry and discharge using the Toronto-Hamilton Lumbar Database. The database assessment is a standardized evaluation for documenting subjective and objective clinical data, and the protocol includes a diagnostic classification system and pain and function ratings. The results of this investigation include a statistically significant (p<.05) decrease in pain and increase in function as measured by the Jan van Breemen pain and disability scales and the Sickness Impact Profile. Seventy-four percent of the treatment group had returned to work by 6 weeks postdischarge from the program. This study suggests that a significant improvement in functional capabilities, a decrease in pain and disability indices, and higher return-to-work rates can be achieved through a 4-week, community-based multiprofessional rehabilitation program.

J Orthop Sports Phys Ther. 1994;20(1):11-16.

Key Words: low back pain, community clinic, standardized assessment