title: Performance problems of patients with chronic low-back pain and the measurement of patient-centered outcome.
abstract: METHODS
  In a prospective interventional study, problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months, before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield, United Kingdom.
  
  
  OBJECTIVE
  To describe problems identified as most important by patients with chronic low-back pain and to evaluate the Canadian Occupational Performance Measure (COPM) as a tool for measuring problem-specific outcomes.
  
  
  BACKGROUND
  Patients with chronic low-back pain report difficulties with a variety of activities. The COPM permits the identification and measurement of problems of particular concern to the patient.
  
  
  METHODS
  COPM, likert-modified Roland and Morris Disability Questionnaire, Pain Self-Efficacy Questionnaire, and 5-minute walk test were administered at baseline, immediately after, and 9 months after intervention. Differences and statistical interactions were determined by nonparametric tests.
  
  
  RESULTS
  Participants identified 60 different types of problem activity, 45 of which were identified by nine or fewer participants. Decreased walking tolerance was the most frequently identified problem (56% of participants). Improvements were observed in all outcomes following intervention. Approximately one third of participants reported improvements two or more COPM units in overall performance and satisfaction with their performance at 9 months. Higher reported performance and satisfaction were associated with greater self-efficacy. Increased reported walking performance was associated with increased observed 5-minute walk distance (R = 0.35, P = 0.02).
  
  
  CONCLUSIONS
  Patients with chronic low-back pain report problems with diverse activities. The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual's goals.
authors.affiliation: Back Pain Unit, Sears Centre, King's Mill Hospital, Notts, United Kingdom. David.walsh@nottingham.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Andrew Walsh
authors.forename: Sarah
authors.initials: S
authors.lastname: Jane Kelly
authors.forename: Primal
authors.initials: P
authors.lastname: Sebastian Johnson
authors.forename: Shanmugasundram
authors.initials: S
authors.lastname: Rajkumar
authors.forename: Kate
authors.initials: K
authors.lastname: Bennetts
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012648:Self Care / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking