title: Measuring outcomes in back care.
abstract: METHODS
  Narrative review.
  
  
  OBJECTIVE
  Describe current issues of outcomes assessment in spine research, with a focus on their application to advocacy oriented research.
  
  
  BACKGROUND
  Outcomes measurement in back pain has advanced substantially over the past decade.
  
  
  METHODS
  Qualitative assessment of outcomes assessment methods when used in advocacy settings.
  
  
  RESULTS
  Researchers and clinicians now have multiple instruments that can assess patient outcomes with adequate psychometric properties. The domains generally assessed include: biologic measures (range of motion, fusion rate); patient-reported outcomes (functional status, quality of life); process measures (hospital days, medication use); and outcomes of interest to society (days off work, health care costs). When research is conducted in the context of advocacy work, care is needed to avoid introduction of bias into the work. Bias in outcomes assessment can occur through multiple phases of the research process, including selection of the research question, study design, measurement, choice of the outcome measures used, and analysis. Bias can also occur in assessing outcomes across studies in literature synthesis.
  
  
  CONCLUSIONS
  Transparency in research methods and clear communication can avoid many of the described pitfalls in outcomes assessment, allowing researchers to advocate appropriately for improvement in patient care.
authors.affiliation: Department of Medicine and The Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, Chapel Hill, NC 27559-7590, USA. carey@mail.schsr.unc.edu
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: Thelma J
authors.initials: TJ
authors.lastname: Mielenz
mesh_terms: D001416:Back Pain / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards*; D012107:Research Design / Q000592:standards*