There are numerous patient satisfaction questionnaires by none specific for an Independent Medical Examination (IME). The aim of this study was to develop and evaluate a questionnaire suitable for an IME. The questionnaire (IMESQ) consisted of five process domains (“Interpersonal manner”, “Communication”, “Technical ability”, “Information exchange”, “Time allocation”) and an outcome domain (“Satisfaction”), each with a five-scale Likert response. An 11-point numerical satisfaction scale (NSS) and a 3-point scale question on the “willing to undergo another examination with the doctor if required” were alternative measures of validation. The questionnaire was tested against numerous independent variables. Statistical analysis included Spearman correlation ((r. S. ) between the items in the questionnaire and the total score with the NSS, and “willing to undergo another examination with the doctor if required” with point-biserial correlation (r. pb. ). Internal consistent reliability was tested using split-half correlation coefficient (r. SB. ) and Cronbach's alpha coefficient (α). The construct was subjected to Factor Analysis. The results from 53 respondents were analysed. There was moderate to strong inter-item correlation (r. s. range 0.57 to 0.83, median 0.67, p < 0.01) and good correlation with the NSS (r. s. = 0.79, p < 0.01) and dichotomous question (r. pb. = 0.45, p < 0.01). Five respondents were “neither satisfied or dissatisfied” (Item 6) and 12 recorded “maybe” to further examination. The split-half correlation was strong (r. SB. = 0.76, p < 0.01). There was good internal consistency reliability (α = 0.92). “Interpersonal manner” (ψ = 4.3) was the only item to have an eigenvalue greater than one, accounting to 72% of the variance across the scale. Eigenvector analysis confirmed the questionnaire was unidimentional. The IMESQ is a brief questionnaire to assess satisfaction with an IME. It is validated and has good internal consistency reliability. The five process domains can identify areas of suboptimal performance: useful for a 360° audit

Background. Disability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI). Methods. Convenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency was also assessed. Results. 403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90) and were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity. Conclusions. A brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted. Conflicts of interest. No conflicts of interest. Sources of funding. No funding obtained

Untreated clubfoot results in serious disability, but mild to moderate residual deformities can still cause functional limitations and pain. Measuring the impact of clubfoot deformities on children's wellbeing is challenging. There is little literature discussing the variability in outcomes and implications of clubfoot based on where geographically the child resides. Although the use of patient reported outcome measures (PROMs) is steadily growing in pediatric orthopaedics, few studies on clubfoot have incorporated them. The most widely used PROM for pediatric foot and ankle pathology is the Oxford Foot and Ankle Questionnaire for Children (OXFAQ-C) that include a physical, school and play, emotional and shoe wear domains. The aim of this study is to evaluate the validity and regional differences in scores of the OXFAQ-C questionnaire to identify functional disability in children with clubfoot in India and Canada. This is a retrospective cohort study of children in Indian and Canadian clubfoot registries aged 5-16 years who completed >1 parent or child OXFAQ-C. The OXFAQ-C was administered once in 01/2020 to all patients in the Indian registry, and prospectively between 06/2019 and 03/2021 at initial visit, 3, 6, 12 months post-intervention, then annually for the Canadian patients. Demographic, clubfoot, and treatment data were compared to OXFAQ-C domain scores. Descriptive statistics and regression analysis were performed. Parent-child concordance was evaluated with Pearson's Coefficient of Correlation (PCC). The cohort had 361 patients (253 from India, 108 from Canada). Non-idiopathic clubfoot occurred in 15% of children in India and 5% in Canada, and bilateral in 53% in India and 50% in Canada. Tenotomy rate was 75% in India and 62% in Canada. Median age at presentation was 3 months in India and 1 month in Canada. Mean Pirani score at presentation and number of Ponseti casts were 4.9 and 6.1 in India and 5.3 and 5.7 in Canada, respectively. Parents reported lower scores in all domains the older the child was at presentation (p Canadians scored significantly lower for all domains (p < 0 .001), with the difference being larger for child-reported scores. The greatest difference was for physical domain. Canadian parents on average scored their child 6.21 points lower than Indian parents, and Canadian children scored a mean of 7.57 lower than Indian children. OXFAQ-C scores differed significantly between Indian and Canadian children despite similar demographic and clubfoot characteristics. Younger age at presentation and tenotomy may improve OXFAQ-C scores in childhood. Parent-child concordance was strong in this population. The OXFAQ-C is an adequate tool to assess functional outcomes of children with clubfeet. Cultural validation of patient reported outcome tools is critical

Aims. To provide normative data that can assess spinal-related disability and the prevalence of back or leg pain among adults with no spinal conditions in the UK using validated questionnaires. Methods. A total of 1,000 participants with equal sex distribution were included and categorized in five age groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years. Individuals with spinal pathologies were excluded. Participants completed the Scoliosis Research Society-22 (SRS-22r), visual analogue scale (VAS) for back/leg pain, and the EuroQol five-dimension index (EQ-5D/VAS) questionnaires, and disclosed their age, sex, and occupation. They were also categorized in five professional groups: doctors, nurses, allied health professionals, office workers, and manual workers. Results. The mean age of all participants was 43.8 years (20 to 69). There was no difference in the SRS-22r, EQ-5D, or VAS scores among male and female participants (p > 0.05). There was incremental decrease in SRS-22r total scores as the age increased. The mean EQ-5D index score (0.84) ranged little across the age groups (0.72 to 0.91) but reduced gradually with increasing age. There was difference between the SRS-22r total score (4.51), the individual domain scores, and the EQ-5D score (index: 0.94 and VAS: 89) for the doctors’ group compared to all other occupational categories (p < 0.001). Doctors had a younger mean age of participants, which may explain their improved spinal health. There was no difference in the total or sub-domain SRS-22r and EQ-5D scores between the other four occupational groups. Conclusion. This study provides the first normative data for the SRS-22r, EQ-5D, and VAS for back/leg pain questionnaires among adults in the UK. We recorded an excellent correlation between the three assessment tools with individuals who reported less back and leg pain having better quality of life and greater function. The participants’ age, rather than their sex or profession, appears to be the major determinant for spinal health and quality of life. Cite this article: Bone Jt Open 2022;3(2):130–134

Objectives. Electronic forms of data collection have gained interest in recent years. In orthopaedics, little is known about patient preference regarding pen-and-paper or electronic questionnaires. We aimed to determine whether patients undergoing total hip (THR) or total knee replacement (TKR) prefer pen-and-paper or electronic questionnaires and to identify variables that predict preference for electronic questionnaires. Methods. We asked patients who participated in a multi-centre cohort study investigating improvement in health-related quality of life (HRQoL) after THR and TKR using pen-and-paper questionnaires, which mode of questionnaire they preferred. Patient age, gender, highest completed level of schooling, body mass index (BMI), comorbidities, indication for joint replacement and pre-operative HRQoL were compared between the groups preferring different modes of questionnaire. We then performed logistic regression analyses to investigate which variables independently predicted preference of electronic questionnaires. Results. A total of 565 THR patients and 387 TKR patients completed the preference question. Of the THR patients, 81.8% (95% confidence interval (CI) 78.4 to 84.7) preferred pen-and-paper questionnaires to electronic questionnaires, as did 86.8% (95% CI 83.1 to 89.8) of TKR patients. Younger age, male gender, higher completed level of schooling and higher BMI independently predicted preference of electronic questionnaires in THR patients. Younger age and higher completed level of schooling independently predicted preference of electronic questionnaires in TKR patients. Conclusions. The majority of THR and TKR patients prefer pen-and-paper questionnaires. Patients who preferred electronic questionnaires differed from patients who preferred pen-and-paper questionnaires. Restricting the mode of patient-reported outcome measures to electronic questionnaires might introduce selection bias. Cite this article: Bone Joint Res 2013;2:238–44

Introduction. W. ide . A. wake . L. ocal . A. naesthetic . N. o . T. ourniquet (WALANT) is a well- established day case procedure for carpal tunnel release with several advantages and enhanced post-operative recovery. Use of Local anaesthesia with Adrenaline using a 27G needle allows a bloodless field and distraction techniques achieve patient comfort during the procedure. Objectives. This retrospective, observational cohort study assesses patient satisfaction and undertakes functional evaluation using the validated Boston Carpal Tunnel Questionnaire (BCTQ) following WALANT technique for carpal tunnel release (CTR). The BCTQ has a symptom severity scale based on 11 items and a functional status scale of 8 elements. Further we compare surgical outcomes between techniques of WALANT and traditional CTR. Patient and Methods. We included 30 consecutive patients, 15 in each arm who either underwent traditional CTR with the use of Tourniquet or with the WALANTtechnique. Data was collected from Electronic Patient Records and hand therapy assessments. A satisfaction questionnaire and Visual Analogue Score (VAS) was utilized to evaluate subjective outcomes. Functional outcomes was assessed by BCTQ scoring system and clinical review. Microsoft Excel was used for analysis. Results. 100% of patients in the WALANT group stated they were satisfied with the operation. Relief from night pain and sleep disturbance were the most improved symptoms. BCTQ and clinical assessment evaluation between both groups revealed comparable results with no significant difference. Conclusion. With advantages of no tourniquet related pain, increased patient satisfaction and functional outcomes on the BCTQ scores, WALANT technique has the potential to be the standard technique for CTR

Background to the study. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. When evaluating outcome it is important to identify a PROM with good measurement properties. Purpose of the study. To review the measurement properties of the low back and neck versions of the Bournemouth Questionnaire. Methods. Bibliographic databases (e.g. EMBASE, MEDLINE, CINAHL and PsycInfo) were searched for articles evaluating the measurement properties of the Bournemouth Questionnaire. Articles were excluded that did not evaluate measurement properties of this instrument. The methodological quality of the studies selected was evaluated using the COSMIN checklist with the four point rating scale. Studies were rated as “excellent”, “good”, “fair” or “poor” based on completion of the checklist. Results. The initial search produced 6265 hits. A total of 13 studies were included in the final evaluation. Seven studies used the Bournemouth Questionnaire neck version, and six studies involved the back version. Cross-cultural translation was reported in six studies, reliability data were reported in eight studies, and responsiveness in ten studies. Conclusion. The review's findings suggest that the Bournemouth Questionnaire has suitable measurement properties for benchmarking practice in musculoskeletal settings. Conflicts of interest. None. Sources of funding. This study was sponsored by the National Council for Osteopathic Research (. www.ncor.org.uk. )

Over 500 supracondylar humerus fractures (SCHF) are treated at our institution each year. Our standard post-operative pathway includes a 3-week visit for splint removal, wire removal, and radiographs. Subsequent follow-up occurs at 12 weeks for a clinical examination. In an effort to minimize unnecessary follow-up visits, we investigated whether photographs and/or patient-reported outcome measure (PROM) scores could identify patients who do not need routine 3-month in-person follow-up. At the 3-month visit, 248 SCHF patients (mean 6.2 yrs; 0.75-11yrs) had bilateral elbow motion (ROM) and carrying angles measured; and photographs documenting frontal and sagittal alignment of both injured and uninjured upper extremities, in both maximum elbow flexion and extension. Two independent assessors made the same measurements off the clinical photographs to compare these with the clinical measurements. Two PROMs: Self-Assessment Questionnaire (SAQ: 0 best to 14 worst) and QuickDASH (0 best to 100 worst) were completed at the 3-month visit. Inter-rater reliability of the photograph measurements was excellent (Kappa: 0.88-0.93), but weakly concordant with clinical measurements (carrying angle Kappa=0.51;max flexion Kappa=0.68;max extension Kappa=0.64). SAQ moderately correlated with QuickDASH (Kappa=0.59) and performed better at identifying patients with abnormalities. SAQ score ≥ 4 identified patients meeting 3-month follow-up criteria, with sensitivity: 36.1%; specificity: 96.8% and negative-predictive-value (NPV): 87%. We did not find that photographs were reliable. Although SAQ-score has high NPV, a more sensitive fracture-specific PROM is needed to identify patients who do not need a 3-month follow-up visit

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is the most reliable surgical option, for hallux rigidus from end-stage osteoarthritis. The aim of the study was to compare the functional outcomes of memory nickel-titanium staples versus a compression plate with a cross screw construct for first MTPJ arthrodesis using the Manchester–Oxford Foot Questionnaire (MOXFQ). Patients who underwent MTPJ arthrodesis using either memory nickel-titanium staples or a compression plate with a cross screw construct were identified from the surgical lists of two orthopaedic consultants. Pre and post-operative MOXFQ questionnaire, a validated patient-reported outcome measure, was administered, and responses were analysed to derive the MOXFQ summary index. The study included 38 patients (staple group N=12 and plate and cross screw group N=26). 23 patients were female and 15 were male. Mean age was 64.8 years (SD 9.02; 40 to 82). Initial analysis showed no significant difference in preoperative MOXFQ scores between the groups (p = 0.04). Postoperatively, the staple group exhibited a mean improvement of 36.17, surpassing the plate group's mean improvement of 23. Paired t-test analysis revealed a statistically significant difference (t-score= 2.5, p = 0.008), favouring the use of staples. The findings indicate that the use of staples in MTPJ arthrodesis resulted in a significantly greater improvement in MOXFQ scores compared to plates. Further research is needed to explore the underlying factors contributing to this difference and to evaluate long-term effects on patient outcomes

Introduction. Patient reported outcome measures (PROMs) and psychological aspects of spinal conditions play an important role in its management. Disability benefit in the social welfare system is being closely scrutinized. The PHQ9 and GAD7 are used widely in general practice to aid assessment of depression and anxiety/somatization. To date, their use in the spinal surgery out patient setting has not been assessed. Materials and Method. Over a one-year period the senior author saw 516 new patients. Each patient completed a standard spinal assessment questionnaire consisting of several demographic/aetiological questions and PROMs (VAS back, VAS leg, ODI/NDI, PHQ9 and GAD7). An analysis of these scores was performed. Results. The mean age was 54 years with 237 males and 279 females. The mean VAS Neck/Back was 6.7, VAS Limb 6, ODI/NDI 48, PHQ9 12 and GAD7 8.7. The PHQ9 and GAD7 correlated strongly with the VAS and ODI/NDI scores (r=0.3–0.4, p<0.0001). The PHQ9 correlated strongly with the GAD7 (r=0.83, p<0.0001). 163 patients (31.6%) were receiving disability benefit. Disability benefit was strongly associated with increasing age, VAS, ODI/NDI, PHQ9 and GAD7 scores (p<0.0001). Patients receiving disability benefit have more concerns regarding their pain and worse PROMs. Similar findings were found in the subgroup of 81 patients with chronic degenerative low back pain. Conclusion. The PHQ9 and GAD7 scores appear to correlate well with the standard spinal disability assessment PROMs (VAS and ODI/NDI). Patients receiving disability benefit appear to have worse PROMs including worse measures of depression and anxiety/somatization

Reported rates of dislocation after primary and revision total hip replacement (THR) vary widely, whereas subluxation after THR is not commonly reported. Importantly, it is now recognised that reported dislocation rates are likely to be an underestimate of the true dislocation rate. The primary aim of this study was to develop and validate a Patient Hip Instability Questionnaire and subsequently to use this questionnaire to determine the incidence of dislocation, subluxation and symptoms due to hip instability following primary and revision THR. In addition the associated costs, morbidity, disability and effects on health-related quality of life were examined. A retrospective review of dislocation rates from 1996 to 1998 identified problems in determining the true dislocation rate from standard hospital and database records. Therefore, a patient-completed Hip Instability Questionnaire was developed and validated to monitor dislocation and subluxation rates. This was then mailed to patients three and 12 months following primary or revision THR. All dislocations were then confirmed by telephone interview and radiographs. Telephone interviews and patient completion of the SF-36 questionnaire were used to assess morbidity, disability and quality of life. Costs of treating patients with hip dislocation were also determined. The response rate to the mailed questionnaire was greater than 95%. The questionnaire was shown to be a valid measure of the true rate of dislocation following THR and confirmed the inaccuracies in previous methods of determining dislocation rate based on hospital and database records. Using this questionnaire, the rate of subluxation was higher than previously reported and the significant morbidity and health care costs associated with with this complication were identified. The use of this questionnaire will allow better assessment of morbidity and costs due to complications following THR

Background. A cornerstone in treating low back pain (LBP) is the provision of information to patients, and the internet is increasingly being used as a source of health information delivery. However, the effect of and satisfaction with online information have been questioned. Purpose. To develop a multi-item instrument to measure an index score of satisfaction with online information for patients with LBP. Methods. The conceptualization of this patient reported outcome is modelled on the assumption of a formative model. The first draft of the questionnaire was developed based on a previous published interview study of 15 patients and evaluated for face validity by seven experts. The second draft of the questionnaire was pilot-tested in 20 patients to optimize content validity. Patients were recruited from a rehabilitation center and from social media. Results. An eight-item questionnaire was developed after assessing content and face validity. The items were related to design, readability, customization, credibility, usability, and coping. A labelled categorical scale was used for response options. Each item is scored from 0–3, where 0 indicates not at all satisfied, 1 indicates little satisfaction, 2 indicates some satisfaction, and 3 indicates very satisfied giving an overall index score between 0 and 24 points. Conclusion. An eight-item questionnaire measuring satisfaction with an index score from 0–24 points has been developed. The OPSI questionnaire is now being tested for construct validity, reproducibility and interpretation on 150 patients with LBP. No conflicts of interest. Sources of funding: Funded by the Novo Nordic Foundation (NNF17OC0024422)

The SF 36 questionnaire has been validated and used in multiple studies. However, it remains unclear how well patients complete the SF-36 questionnaire in a spinal outpatient clinic setting outside the context of a study. We aim to assess the quality of information gained if the SF 36 is used as an audit and outcome measure in real clinical practice. The SF 36 has been used in our clinic as a routine for the initial assessment and outcome audit of patients for the last 4 years. A prospective, consecutive sample of 85 patients’ SF-36 forms was evaluated during a spinal out-patient clinic over one month at our teaching hospital. Completeness of data entry was assessed. All patients had access to a translator and clinic nurse to help complete the questionnaire if needed. There were 34 males and 51 females (age range 16 to 81, average 48). Thirty seven patients were White British, 22 other and 26 undisclosed ethnicities. Thirty eight (45%) forms were complete leaving 47 (55%) which had at least one question unanswered or spoiled. Of these, two had five to ten errors, one had 10 to 15 errors, four had 15 to 20 errors, seven had 20 to 25 errors, ten had 25 to 30 errors and 17 had 30 to 35 errors. In addition six forms were entirely incomplete beyond patient identifier information. White British patients had fewer errors (average 4) compared to other (9) and unknown (9) ethnicities. Outside the context of a research study, the SF-36 questionnaire in an urban teaching hospital spinal outpatient clinic is not a reliable tool. Redesign of the questionnaire may be required. The SF-36 questionnaire is less well completed by patients declared as non White British, even with the facility for a clinic nurse and a translator

Aims. Responsiveness to clinically important change is a key feature of any outcome measure. Throughout Europe, health-related quality of life following total knee arthroplasty (TKA) is routinely measured with EuroQol five-dimension (EQ-5D) questionnaires. The Patient-Reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10 Global Health) score is a new general heath outcome tool which is thought to offer greater responsiveness. Our aim was to compare these two tools. Patients and Methods. We accessed data from a prospective multicentre cohort study in the United Kingdom, which evaluated outcomes following TKA. The median age of the 721 patients was 69.0 years (interquartile range, 63.3 to 74.6). There was an even division of sex, and approximately half were educated to secondary school level. The preoperative EQ-5D, PROMIS-10, and Oxford Knee Scores (OKS) were available and at three, six, and 12 months postoperatively. Internal responsiveness was assessed by standardized response mean (SRM) and effect size (Cohen’s d). External responsiveness was assessed by correlating change scores of the EQ-5D and PROMIS-10, with the minimal clinically important difference (MCID) of the OKS. Receiver operating characteristic (ROC) curves were used to assess the ability of change scores to discriminate between improved and non-improved patients. Results. All measures showed significant changes between the preoperative score and the various postoperative times (p < 0.001). Most improvement occurred during the first three months, with small but significant changes between three and six months, and no further change between six and 12 months postoperatively. SRM scores for EQ-5D, PROMIS-10, and OKS were large (> 0.8). ROC curves showed that both EQ-5D and PROMIS-10 were able to discriminate between patients who achieved the OKS MCID and those who did not (area under the curve (AUC) of 0.7 to 0.82). Conclusion. The PROMIS-10 physical health tool showed greater responsiveness to change than the EQ-5D, most probably due to the additional questions on physical health parameters that are more susceptible to modification following TKA. The EQ-5D was, however, shown to be sensitive to clinically meaningful change following TKA, and provides the additional ability to calculate health economic utility scores. It is likely, therefore, that EQ-5D will continue to be the global health metric of choice in the United Kingdom. Cite this article: Bone Joint J 2019;101-B:832–837

Aim: The aim of this study was to validate the SF12 questionnaire for use with patients with anterior glenohumeral instability. This was done with a view to replacing the longer parent questionnaire, the SF36 if a comparative level of validity was found with this patient group. Method: Patients attending the a shoulder clinic with at least one previous, documented episode of anterior glenohumeral joint dislocation were asked to complete the SF12, Oxford Instability, Oxford General Shoulder and SF36 questionnaires recording their level of shoulder function and general health status. Twenty subjects agreed to participate in the study. The results of the four questionnaires were scored according to the instructions issued by their authors, zeroed and converted into percentages to allow them all to be compared on the same scale then they were tabulated for comparison. The score on the questionnaires for each patient and the difference between the scores was calculated and plotted. The mean and standard deviation of the differences was then also plotted to assess the spread of the results (Bland and Altman’s method). Results: The mean age of the subjects was 33.5 years (range 16 to 75 years). Three subjects were female and seventeen male. Conclusion: The study suggests that the SF12 is suitable to be used as a replacement for the SF36. It shows a similar correlation with the ‘gold standard’ shoulder specific Oxford Instability score and displays a good correlation with the SF36 compared to the other measures

Background: Symptom modifying factors (SMFs) are everyday activities or postures that are reported to aggravate or alleviate existing LBP symptoms. In relation to sedentary jobs, workers are known to experience LBP whilst sat at work, and may report that aspects of sitting either aggravate or alleviate their symptoms. These factors appear to have received little attention in the literature, and may help to discriminate workers with different types of LBP, or identify workers likely to take sickness absence due to LBP. Methods: A new sitting and symptom modifying factors questionnaire (SSMQ) was designed and consisted of 11 items. This questionnaire was distributed to 135 sedentary workers on two occasions with a 2 week time lapse. Principal components analysis (PCA) and Cronbach’s alpha were used to explore the structure and internal consistency of the questionnaire. Paired t-tests were used to determine test-retest stability. Results: Three factors with eigenvalues > 1 were extracted that explained 62% of the total variance, and each factors items loaded > 0.06. These sub-scales related to aggravating and relieving (movement and posture) factors, and had consistency levels of 0.80, 0.72 and 0.78 respectively. The retest response rate was 46% and there were no statistically significant differences (p > 0.05) between test-retest measures. Conclusions: Validating the SSMQ has produced an instrument that can be used in sedentary jobs to investigate the influence of symptom modifying factors on LBP symptoms, care seeking and sickness absence due to LBP. This questionnaire will now be used in a prospective study of sedentary call centre workers

Background: Disability questionnaires for LBP-patients mostly emanate from health professionals and have a content of different domains of disability presented as a single sum score, making it difficult to derive changes within a specific domain. This study introduces a new back-specific questionnaire, the Profile Fitness Mapping questionnaire (PFM), which was based on patient’s self-reported characteristics of the LBP. The PFM incorporates both a functional limitation and a symptom scale, with further subdivision of the symptom scale in separate indices for severity and temporal aspects. The aim of the study was to assess the overall validity of the PFM. Methods and Results: Chronic LBP-patients (n=193) answered the PFM and four validated back-specific criterion questionnaires. The correlation coefficients between the PFM and the criterion questionnaires showed good concurrent criterion validity (0.61 – 0.83). The best discriminative ability between patients with different pain severity was demonstrated by the functional limitation scale of the PFM. Classification according to the ICF revealed a high degree of homogeneous item content of the symptom scale to the domain of impairments, and of the functional limitation scale to the domain of activity limitations. Well centered score distribution indicates that the PFM has the potential to detect improvement or worsening of symptoms and functional limitations in chronic LBP-patients. Conclusion: The results of the study signify that the PFM is a valid indicator of symptoms and functional limitations of LBP-patients. It provides the combination of a composite total score and the possibility of evaluations within specific domains of disability

Purpose of the study: The principal aim of this prospective multicentric observational study was to validate an self-administered questionnaire for evaluation of functional outcome after surgical treatment of lumbar stenosis. The questionnaire was associated with an index of neurological impairment in order to account for objective neurological injury and an index exploring patient satisfaction after treatment for lumbalgia, radiculalgia and gait disorders. Material and methods: The structure of the questionnaire was examined to determine whether the three dimensions of the evaluation scale were pertinent, to establish reproducibility (intra-observer variability), to study sensitivity to change, and finally to examine the items in the questionnaire and their capacity for effective measurement using the Cronbach alpha coefficient and principal components analysis. Reproducibility was tested on 49 patients who filled out the self-administered questionnaire twice, 15 days apart. The intra-class coefficients of correlation were calculated. Sensitivity was tested by correlating the variations of the scores obtained pre- and postoperatively with the index of satisfaction and by calculating mean standardised responses. The questionnaire items were validated by correlating the scores obtained using the questionnaire with scores obtained with three other self-administered questionnaires: SF36, EIFFEL2 and GHQ28. Results: One hundred four patients were included in this study, 96 were seen at follow-up visits six and twelve months after surgery. Principal component analysis demonstrated the pertinence of the three dimensions in the evaluation scale. The overall Cronback alpha was 0.86. The overall intra-class coefficient of correlation was 0.95, varying from 0.86 to 0.97 for the dimensions studied. There was a good correlation (0.82) between the scores obtained and index of satisfaction. All mean standardised responses were greater than A1, indicating good sensitivity to change. There was a good correlation between the evaluated score and the EIFFEL2 self-administered questionnaire and the following dimensions of the SF36: physical activity, physical pain, vitality and limitation due to physical pain. Discussion and conclusion: Using a simple self-administered questionnaire (eight questions), an index of satisfaction (four questions) and an objective score of neurological disorders allowed reliable, sensitive and reproducible assessment of the changes in the functional impairment caused by lumbar stenosis before and after surgical treatment

Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb. Various methods are used to diagnose this condition including clinical examination and neurophysiologic tests. The DASH (Disability of Arm, Shoulder and Hand) score is also commonly used to quantify the symptoms from the patients’ perspective. The aim of this study was to determine any correlation between the neurophysiology and the various questions in the DASH score. To the best of our knowledge this potential association has not been studied previously. Methods: We reviewed 55 patients who underwent carpal tunnel surgery under the care of the senior author. Case notes were reviewed to extract the DASH score, clinical signs and neurophysiology results. DASH questionnaires are routinely given to all our new patients in the hand clinic and we used these questionnaires for the study (pre operative scores). All the patients were examined clinically by the senior author. The clinical signs used included direct compression, Tinel’s and Phalen’s test. Neurophysiologic testing was conducted by two specialists using a standard format which allowed us to extract the data consistently. Analysis: The data was analysed using linear and logistical regression methods. Results: Of 55 patients, 9 had bilateral surgery, resulting in 64 sets of data. There were 44 females and 11 males, with a mean age of 62 (range 36 – 86) years. The mean DASH score was 38.0 (range 0.8 – 85.0). The relationship between the component scores of the DASH questionnaire and neurophysiology tests will be presented in further detail. Conclusion: The results of this study may facilitate an abbreviation of the DASH questionnaire, making it more focused to patients with carpal tunnel syndrome

This randomised methodological study sought to test the reliability of an Internet questionnaire and investigate the differences in response rates between traditional pen-and-paper questionnaires and Internet questionnaires for measuring patient-reported outcome after total hip arthroplasty (THA) surgery. From the Swedish Hip Arthroplasty Register, 2 400 patients were chosen at random but stratified by age, sex and diagnosis for inclusion in a four-year follow-up using the health-related quality of life (HRQoL) tool EQ-5D and visual analogue scales for pain and satisfaction. The patients were randomized to answer the follow-up model protocol either via a password-protected Internet questionnaire or via a mailed pen-and-paper questionnaire. A reliability test for the Internet follow-up instrument showed adequate correlation. However, the Internet group and the pen-and-paper group differed significantly (p<0.001) with a 92% response rate in the latter and 49% in the former. Adjusted to the normal age distribution of the THA population, the Internet response rate was 34%. The patient-administered Internet questionnaire alone does not give a sufficient response rate in the THA population to replace the pen-and-paper questionnaire. However, the system is reliable and could be used for measuring patient- reported outcome if supplemented with traditional pen-and-paper questionnaires for Internet non-respondents. It is expected that this answer procedure will soon predominate in view of the general development of Internet functions. Register work may then become less resource-consuming and the results may be analysed in real time