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Measure Summary
Title
Adult acute and subacute low back pain: percentage of patients with low back pain diagnosis who have their functional status assessed using the Oswestry Disability Questionnaire or other assessment tool.
Source(s)
Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, Johnson K, Kramer C, Mueller B, Peterson S, Setterlund L, Timming R. Adult acute and subacute low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Nov. 91 p. [133 references]

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of patients age 18 years and older with low back pain or radiculopathy diagnosis who have their functional status assessed using the Oswestry Disability Questionnaire or other assessment tool.

Rationale

The priority aim addressed by this measure is to increase the utilization of validated pain and function scales to help differentiate treatment approaches in order to improve the patient's ability to function.

Of the 354 million patient visits per year for acute care in the United States only 42% are seen by primary care providers: 28% are seen in the emergency room and 20% are seen by specialists. Visits to primary care clinicians for low back pain are equally split between chiropractors and allopathic clinicians, with low back pain as the fifth most common reason for an office visit to all clinicians. The majority of these visits are not because of pain but rather due to the disability associated with the low back symptoms.

It is estimated that only 15% of all low back pain has an identifiable anatomic explanation. The other 85% is identified as non-specific low back pain. The concept that most low back pain is related to a specific injury is challenged by the recent work of multiple authors showing a limited relationship between low back pain and physical exposures. The discussion of the pathophysiology indicates that it is a multifactorial symptom, which may start with an injury reaction but is exacerbated by concomitant factors that may extend symptoms far past the normal healing time for injured tissues. Co-factors that contribute to persistent pain may include deconditioning, psychological issues, other chronic illnesses, genetics and even culture.

The Oswestry Disability Questionnaire is used to assess the patient's subjective rating of perceived disability related to his or her functional limitations, e.g., work status, difficulty caring for oneself. The higher the score, the more perceived disability. Using this test at the initial visit helps the examiner understand the patient's perception of how his or her back pain is affecting his or her life. There are two ways that this test aids in the treatment of back pain. A higher score is indicative of the need for more intensive treatment such as spinal manipulative therapy and education to help the patient understand the low likelihood of disability related to back pain. Understanding the low likelihood helps prevent the fear of disability from becoming a barrier to improvement.

Evidence for Rationale
Bakker EW, Verhagen AP, van Trijffel E, Lucas C, Koes BW. Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies. Spine (Phila Pa 1976). 2009 Apr 15;34(8):E281-93. [50 references] PubMed External Web Site Policy

Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7. [14 references] PubMed External Web Site Policy

Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. Factors defining care-seeking in low back pain--a meta-analysis of population based surveys. Eur J Pain. 2010 Aug;14(7):747.e1-7. PubMed External Web Site Policy

Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, Johnson K, Kramer C, Mueller B, Peterson S, Setterlund L, Timming R. Adult acute and subacute low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Nov. 91 p. [133 references]

Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. Spine J. 2010 Jan;10(1):89-99. [52 references] PubMed External Web Site Policy

Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976). 1995 Jan 1;20(1):31-7. PubMed External Web Site Policy

Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. Spine J. 2010 Jan;10(1):76-88. [55 references] PubMed External Web Site Policy

Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J. 2010 Jun;10(6):554-66. [62 references] PubMed External Web Site Policy

Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010 Sep;29(9):1630-6. PubMed External Web Site Policy
Primary Health Components

Acute or subacute low back pain; functional status; assessment tool; Oswestry Disability Questionnaire

Denominator Description

Number of patients with diagnosis of acute or subacute low back pain or radiculopathy (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients who have their functional status assessed using the Oswestry Disability Questionnaire or other assessment tool

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
Additional Information Supporting Need for the Measure
  • The majority of individuals with an episode of acute low back pain improve and return to work within the first two weeks. The probability of recurrence within the first year ranges from 30% to 60%. Most of these recurrences will recover in much the same pattern as the initial event. In as many as one-third of the cases, the initial episode of low back pain persists for the next year. Most of these individuals continue to function with only limited impairment.
  • Most of the total cost for low back pain is dedicated to the small percentage of sufferers whose condition has progressed to the chronic disabling stage (pain for more than 12 weeks). The medical costs for low back pain in general were estimated at $26.3 billion in 1998 and now are one-third to one-fourth of the total cost of care. Lost production and disability account for other costs. Disability alone claims 80% of the total expense of this condition. Expenditures for medical care and disability continue to increase. The human cost is equally significant; low back pain is currently the second most common cause of disability in the United States and is the most common cause of disability in those under age 45.
  • Approximately two-thirds of the people who recover from a first episode of acute low back symptoms will have another episode within 12 months.
  • Low back pain, alone or in combination with pelvic pain, is a common problem suffered by women during pregnancy. Studies estimate 50% to 80% of women will suffer from low back pain during pregnancy, and one study found that approximately 62% of pregnant women suffering from low back pain rated it as moderately severe. Despite the significance of this problem, only one-third of pregnant women reported low back pain to their prenatal care providers.
Evidence for Additional Information Supporting Need for the Measure
Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults--United States, 2005. MMWR Morb Mortal Wkly Rep. 2009 May 1;58(16):421-6. PubMed External Web Site Policy

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91. PubMed External Web Site Policy

Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, Johnson K, Kramer C, Mueller B, Peterson S, Setterlund L, Timming R. Adult acute and subacute low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Nov. 91 p. [133 references]

Hayden JA, Dunn KM, van der Windt DA, Shaw WS. What is the prognosis of back pain?. Best Pract Res Clin Rheumatol. 2010 Apr;24(2):167-79. PubMed External Web Site Policy

Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003 Apr;12(2):149-65. [46 references] PubMed External Web Site Policy

Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976). 2004 Jan 1;29(1):79-86. PubMed External Web Site Policy

Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ. 2003 Aug 9;327(7410):323. [9 references] PubMed External Web Site Policy

Pennick V, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. In: The Cochrane Library [database online]. issue 4. ; 2008 [accessed 2013 Apr 15].

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun;1(2):137-41. PubMed External Web Site Policy

Stapleton DB, MacLennan AH, Kristiansson P. The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. Aust N Z J Obstet Gynaecol. 2002 Nov;42(5):482-5. PubMed External Web Site Policy
Extent of Measure Testing

Unspecified

National Guideline Clearinghouse Link

State of Use of the Measure

State of Use
Current routine use
Current Use
Internal quality improvement

Application of the Measure in its Current Use

Measurement Setting
Ambulatory/Office-based Care
Professionals Involved in Delivery of Health Services
Physicians
Least Aggregated Level of Services Delivery Addressed
Clinical Practice or Public Health Sites
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age

Age greater than or equal to 18 years

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness

Data Collection for the Measure

Case Finding Period

The time frame pertaining to data collection is monthly.

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Clinical Condition
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions

Inclusions
Number of patients with diagnosis of acute or subacute low back pain or radiculopathy

Population Definition: Patients 18 years and older seen in primary care.

Exclusions
Unspecified

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions
Number of patients who have their functional status assessed using the Oswestry Disability Questionnaire or other assessment tool

Exclusions
Unspecified

Numerator Search Strategy
Fixed time period or point in time
Data Source
Electronic health/medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Oswestry Disability Questionnaire

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Percentage of patients with low back pain diagnosis who have their functional status assessed using the Oswestry Disability Questionnaire or other assessment tool.

Measure Collection Name
Submitter
Institute for Clinical Systems Improvement - Nonprofit Organization
Developer
Institute for Clinical Systems Improvement - Nonprofit Organization
Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: Michael Goertz, MD, MPH (Work Group Leader) (HealthPartners Medical Group) (Preventive and Occupational Medicine); David C. Thorson, MD (Work Group Leader) (Entira Family Clinics) (Sports Medicine and Family Medicine); Robb Campbell, MD, MPH (3M) (Occupational Medicine); Becky Mueller, DO (CentraCare) (Family Medicine and Sports Medicine); Jeff Bonsell, DC (HealthPartners Medical Group and Regions Hospital) (Chiropractic Medicine); Bret Haake, MD (HealthPartners Medical Group and Regions Hospital) (Neurology); Richard Timming, MD (HealthPartners Medical Group and Regions Hospital) (Physical Medicine and Rehabilitation); Brian Bonte, DO (Hutchinson Medical Center) (Family Medicine); Steve Peterson, PT (Orthopaedic Sports, Inc.) (Physical Therapy); Chris Kramer, PT, DPT, OCS, FAAOMPT (Park Nicollet Health Services) (Physical Therapy); Kari Johnson, RN (Institute for Clinical Systems Improvement [ICSI]) (Clinical Systems Improvement Facilitator); Linda Setterlund, MA, CPHQ (ICSI) (Clinical Systems Improvement Facilitator)

Financial Disclosures/Other Potential Conflicts of Interest

The Institute for Clinical Systems Improvement (ICSI) has long had a policy of transparency in declaring potential conflicting and competing interests of all individuals who participate in the development, revision and approval of ICSI guidelines and protocols.

In 2010, the ICSI Conflict of Interest Review Committee was established by the Board of Directors to review all disclosures and make recommendations to the board when steps should be taken to mitigate potential conflicts of interest, including recommendations regarding removal of work group members. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report Clinical Practice Guidelines We Can Trust (2011).

Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group.

The complete ICSI policy regarding Conflicts of Interest is available at the ICSI Web site External Web Site Policy.

Disclosure of Potential Conflicts of Interest

Jeffrey Bonsell, DC (Work Group Member)
Chiropractor, Preferred Chiropractic, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: Counsel for Chiropractic Guideline and Practice Parameters Acute and Chronic Low Back Pain guideline Task Force member
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Brian Bonte, DO (Work Group Member)
Physician, Family Medicine, Hutchinson Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Robb Campbell, MD, MPH (Work Group Member)
Senior Occupational Physician, Occupational Medicine, 3M
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Owns stock with GlaxoSmithKline and Intuitive Surgical

Michael Goertz, MD, MPH (Work Group Co-Leader)
Physician, Preventive Medicine and Occupational Medicine, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: Serves on the advisory committee for American College of Occupational and Environmental Medicine
Guideline Related Activities: ICSI Management of Chronic Pain Guideline
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Bret Haake, MD (Work Group Member)
Neurology Department Head, Assistant Medical Director of Neuroscience, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Chris Kramer, PT, DPT, OCS, FAAOMPT (Work Group Member)
Physical Therapist, Park Nicollet Health Systems
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Payment for development of education presentation from the University of Minnesota Physical Therapy program and St. Kate's Physical Therapy program for the topic of spinal manipulation

Becky Mueller, DO (Work Group Member)
Physician, Family Medicine/Sports Medicine, CentraCare
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Steve Peterson, PT (Work Group Member)
Clinic Manager, OSI Physical Therapy
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: ICSI Headache Guideline work group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Dave Thorson, MD (Work Group Co-Leader)
Medical Director, Sports Medicine and Family Medicine, Entira Family Clinics
National, Regional, Local Committee Affiliations: Board member for the Minnesota Medical Association Trustees and the Midwest Medical Insurance Company.
Guideline Related Activities: American Academy of Family Practice Commission of Health of Public and Science guideline group.
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Richard Timming, MD (Work Group Member)
Physician, Physical Medicine and Rehabilitation, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: ICSI Management of Chronic Pain Guideline work group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2012 Nov
Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)
Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, Johnson K, Kramer C, Mueller B, Peterson S, Setterlund L, Timming R. Adult acute and subacute low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Nov. 91 p. [133 references]
Measure Availability

The individual measure, "Percentage of Patients with Low Back Pain Diagnosis Who Have Their Functional Status Assessed Using the Oswestry Disability Questionnaire or Other Assessment Tool," is published in "Health Care Guideline: Adult Acute and Subacute Low Back Pain." This document is available from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; e-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 15, 2013.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization.

If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties. If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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