Author: Richard H. Adler

Traditionally, objective measurements of soft-tissue injury such as palpable spasm, loss of lordotic curve on x-ray, etc., have been thought reliable as "hard evidence" when measuring the extent of injury and the effectiveness of treatment, while subjective pain and function assessments were criticized as "soft evidence." However, subjective pain assessments as measured through time-tested pain questionnaires have gained substantial acceptance in use and are now considered "hard evidence." Deyo, R. A., and Diehl, A. K. (1983), "Measuring Physical and Psycho-Social Function in Patients with Low Back Pain," Spine, 8(6): 635 - 642; McDowell, I., and Newell, C. (1987), "Measuring Health: A Guide to Rating Scales and Questionnaires," Oxford University Press, New York and Oxford; and Fairbank, J., Coupar, J., et al. (1980), "The Oswestry Low Back Pain Disability Questionnaire," Physiotherapy, 66: 271 - 273.

A pain questionnaire, when used together with objective physical measurements, is considered the most reliable assessment of function and disability in the area in which there is no universal norm. One such pain questionnaire is the Oswestry Index, which was developed in 1976 in a hospital spine unit in Oswestry, Shropshire, England. It scores patients' disability in ten different areas including intensity of pain; ability to lift, walk, sit, and stand; ability for self-care; and impact on social interactions, sex life, sleep, and travel.

Studies have confirmed that the Oswestry Index has good validity (scores improve as patient disability lessens) and reliability (scores are consistent when answered on different occasions by a patient remaining in the same condition). See Fairbank, J., Coupar, J., et al. (1980), "The Oswestry Low Back Pain Disability Questionnaire," Physiotherapy, 66: 271 - 273. After many refinements, this questionnaire is widely used in both research and clinical practice in Britain. Self-rating disability questionnaires are also in wide use in North America.

As health care providers know, all tools that assist in documenting the nature and extent of a patient's injury and the patient's improvement with treatment are vital. A well-formatted and consistently used pain questionnaire can assist you in monitoring the reasonableness and necessity of your treatment (by showing the functional day-to-day improvements of your patient) for insurance or medical-legal purposes. There is the added benefit that when asked to submit a narrative report or testify at a deposition or trial, you will be invaluably aided in recounting the patient's treatment by the assessment of progress and/or remaining levels of pain and dysfunction.

I am enclosing a copy of the Oswestry Low Back Pain Disability Questionnaire, as well as a Neck Disability Index Questionnaire. These are reproduced from the original study and are attached for use in your practice.

As you know, good record keeping tools protect both you and your patient. I hope you find this information and the attached questionnaires useful.

Very truly yours,
ADLER GIERSCH, P.S.

Richard H. Adler
Attorney at Law