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Saragiotto B.1, Maher C.1, Cook C.2, Hancock M.3, New C.4, Hodges P.5
1The George Institute for Global Health, The University of Sydney, Musculoskeletal Division, Sydney, Australia, 2Duke University School of Medicine, Division of Physical Therapy, Durham, United States, 3Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia, 4Sydney Medical School, The University of Sydney, Nepean Clinical School, Sydney, Australia, 5The University of Queensland, School of Health and Rehabilitation Sciences, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, Brisbane, Australia
Background: Low back pain (LBP) is a prevalent condition commonly associated with disability and high costs for patients and health care systems. Although most patients with LBP fit the classification of 'non-specific' LBP (i.e., LBP not attributed to a recognisable or specific pathology) some researchers suggest that non-specific LBP is a heterogeneous group of conditions. They advocate that non-specific LBP patients should be classified into subgroups of patients who will respond better to one treatment than another. One proposed subgroup of patients is lumbar spine instability. Cook et al (2006) established a consensus list of clinical features associated with clinical instability of the spine in a Delphi study. Based on this consensus list, the Lumbar Spinal Instability Questionnaire (LSIQ) was developed. The LSIQ is a self-report measure of 15 items where high scores indicate greater self-reported clinical instability. It showed promise in predicting patients who respond to motor control intervention in a previous trial. However a comprehensive evaluation of the psychometric properties of this measure is needed.
Purpose: The aim of this study was to evaluate the clinimetric properties of the LSIQ in a sample of patients with non-specific LBP.
Methods: We included patients with non-specific LBP aged between 18 to 80 years presenting to primary care clinicians for treatment in Australia. We excluded patients with previous spinal surgery, spinal pathology (e.g., tumor, infection, fracture), pregnancy, or nerve root compromise. Patients completed the LSIQ at baseline, and at least 24-hours later. Internal consistency was tested using Cronbachs alpha and alpha if item deleted. Test-retest reliability was tested using the Intraclass Correlation Coefficient (ICC) for total scores, and Kappa coefficient for each item. Convergent and divergent validity were assessed by correlating the LSIQ items with the Pain Detect Questionnaire (PD-Q) items using Pearsons product-moment correlation coefficient. Finally, potential ceiling and floor effects were measured by calculating the percentage of participants reporting the minimum or maximum possible scores.
Results: A total of 107 participants were recruited (59 men and 47 women), being mostly middle aged (mean [SD]: 49.5 [16.6] years) with chronic LBP. The average pain intensity (SD) was 51 points (22.8) on a 0 to 100 pain numerical rating scale. The LSIQ showed good reliability for total score (ICC: 0.84, 95% Confidence Interval (CI): 0.77 to 0.89), and moderate to substantial reliability for each item (Kappa ranging from 0.57 to 0.78). The internal consistency was borderline with a Cronbach´s alpha of 0.63. There was evidence for construct validity analysis with a moderate correlation observed between the LSIQ and the PD-Q (r=0.57). We did not detect ceiling and floor effects.
Conclusion(s): The LSIQ showed satisfactory estimates for most tested measurement properties. These results suggest that the questionnaire can be used in clinical practice and research.
Implications: The LSIQ is a simple and easy measure to be used in clinical practice. However, future studies are needed to better investigate its internal consistency (if items measure the same general construct) and whether the LSIQ is really able to identify those patients who benefit more from motor control exercise.
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval: Approved by the Research Ethics Committee of the University of Sydney, Australia (Project No.: 2015/563)
All authors, affiliations and abstracts have been published as submitted.
