title: The Maine-Seattle back questionnaire: a 12-item disability questionnaire for evaluating patients with lumbar sciatica or stenosis: results of a derivation and validation cohort analysis.
abstract: METHODS
  Analysis of health-related quality of life data obtained from a prospective cohort study of patients with sciatica due to an intervertebral disc herniation or lumbar spinal stenosis.
  
  
  OBJECTIVE
  To derive and validate a shortened version of a previously validated 23-item modification of the Roland-Morris Disability Questionnaire.
  
  
  BACKGROUND
  For patients with low back pain, improving health-related quality of life is often the main goal of therapy. The Roland-Morris Disability Questionnaire is one of the best validated and most frequently used back-specific functional status measures. A shortened version may permit more widespread use in clinical and research settings.
  
  
  METHODS
  Data from 507 patients with sciatica enrolled in the Maine Lumbar Spine Study were used to derive a shortened version of a 23-item modification of the original Roland-Morris Disability Questionnaire using qualitative and cluster analysis techniques. The internal consistency, construct validity, reproducibility, and responsiveness in detecting change over a 3-month period for a new 12-item scale was compared to the original 23-item scale. The 12-item scale was then validated in an independent cohort of 148 patients with lumbar spinal stenosis.
  
  
  RESULTS
  Internal consistency was very good but modestly lower for the 12-item instrument compared to the 23-item original scale. Reproducibility over a 3-month interval was good and did not differ between the 12-item and original scale. Findings from the validation cohort were similar or better than the derivation cohort. A high degree of construct validity with patient-reported symptoms was demonstrated for the 12-item and original scales. The responsiveness and interpretability of the 12-item scale over 3 months was excellent and comparable to the original scale. Responsiveness assessed in patients with lumbar spinal stenosis in the independent validation cohort showed consistent findings compared to patients with a disc herniation in the derivation cohort.
  
  
  CONCLUSIONS
  This short, simple, self-administered 12-item back-specific functional status questionnaire performed extremely well in comparison with the original 23-item scale. If validated in additional study populations, this new questionnaire may be useful in the clinical setting as a way for providers to prospectively compare their outcomes of care to other patient populations, and to study treatment effectiveness.
authors.affiliation: General Medicine Division and the Clinical Epidemiology Unit, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. satlas@partners.org
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Melissa
authors.initials: M
authors.lastname: van den Ancker
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Robert B
authors.initials: RB
authors.lastname: Keller
authors.forename: Donald L
authors.initials: DL
authors.lastname: Patrick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D015203:Reproducibility of Results; D012585:Sciatica / Q000209:etiology / Q000628:therapy; D013130:Spinal Stenosis / Q000150:complications; D011795:Surveys and Questionnaires / Q000592:standards