Outcome measures for low back pain research. A proposal for standardized use.
Dr. Richard Deyo remains one of the most influential physicians and researchers largely in the area of low back pain having published over 300 peer reviewed articles. His work has included focus in outcome measures, evidenced based practice and management of back pain, health policy and economics of care.
This paper published in 1998 represents a proposal to spine researchers to adopt a set of standardized outcome measures that were developed by an international panel of investigators in 1997. The author’s believed that there was little standardization of research making it difficult to validate some conclusions and presenting challenges in comparing studies. Historically, surgical outcomes have been commonly rated using a scale of excellent, good, fair, or poor. As the authors have noted, this type of rating scale has several potential flaws in addition to its subjective nature. The call for a more standardized set of outcome measures would make it easier to compare study results and assess the magnitude of a specific treatment. The added advantage of having a core set would allow for the ability to integrate effectiveness of a treatment and cost-effectiveness by adding more metrics to the standardized outcome measurement set.
The proposed core outcome measures as presented by Deyo et al was 6 questions in length and encompassed the domains of pain symptoms, function, well-being, disability, and satisfaction with care. Each of the specific measures chosen had been previously validated in other questionnaires. This work was supported in part by a grant from the Agency for Health Care Policy and Research.
At present, both the American Academy of Orthopaedic Surgeons (AAOS) and The North American Spine Society (NASS) maintain a compendium of validated outcome measures covering everything from standard clinical measures, levels of disability, and function to varying psychosocial measures. While the proposed core outcome measures presented by Deyo et al have not been universally adopted in whole form, some of the individually validated components are commonly seen in the current literature of low back pain studies. In the opinion of Spineopedia, this publication by Deyo et al leaves the reader with two key points that remain valid especially in light of current day practice shift to a value based care system:
- There needs to be a validated standardized common set of outcome measures that are disease or condition specific that researchers can use in addition to other study measures so as to improve the quality of the scientific literature and enhance evidence based practice.
- The development of standardized measures needs to take into account many different factors (practicality, costs, validity) with the most significant being the importance to both the patient and society. These last two have commonly been overlooked.