SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
ANNEX B:
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ANNEX B: QUESTIONNAIRES AND INSTRUMENTS
This document contains information relating to the instruments recommended as meeting the scientific
quality threshold by the expert panel. Information describing the questionnaires and other instruments are
outlined for the following areas; Pain and quality of life; Occupational risk factors for low back pain; Low
back pain; Hip and Knee; Foot and Ankle; and Shoulder. There are 19 instruments in total.
After reviewing the information in this document please complete the CONSULTATION RESPONSE
DOCUMENT (ANNEX C of the Consultation Document).
Pain and quality of life
1. SF-36
2. SF-12
3. Brief Pain Inventory
Occupational risk factors for low back pain
4. Obstacles to Return to Work Questionnaire (ORTWQ)
Low back pain
5. Oswestry Disability Index
6. Roland and Morris Disability Questionnaire (24 item)
7. Tampa Scale of Kinesiophobia
Hip and knee
8. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC)
9. Timed Get Up and Go (TUG) Test
10. Lysholm Knee Scale
11. Patellofemoral Pain Syndrome Severity Scale (PSS)
12. WOMET
Foot and ankle
13. Foot and Ankle Ability Measure (FAAM)
14. Manchester Foot Pain and Disability Index
15. American Academy of Orthopaedic Surgeons Lower limb Outcomes Assessment Instrument
Shoulder.
16. American Shoulder and Elbow Surgeons (ASES) Subjective Shoulder Scale
17. Disability of Arm, Shoulder and Hand (DASH or quick DASH)
18. Shoulder Pain and Disability Index (SPADI)
19. Oxford Shoulder Score
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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PAIN AND QUALITY OF LIFE
Instrument
SF-36
Description
SELF REPORT QUESTIONNAIRE
SF-36 is a general health questionnaire (36 questions) that measures: general health
perception, physical function, physical role, bodily pain, social functioning, mental health,
emotional role, vitality, change in health & a global summary score.
Feasibility
Patient Burden
o Contains items of importance to patients: see above
o Comfort and convenience to patients: paper based, can be done by phone or web/
simple wording/ has been translated into numerous languages
o Time to administer: 20 minutes
Clinician Burden
o Cost: licence/ user fee around $750 per 500 copies
o Training required: some training required on scoring/ there is a manual & online
scoring service (at a cost?)
o Ease of scoring & interpretation of results: requires around 10 minutes to score/
normative data available/ some items are reverse scored/ somewhat complex scoring
method/ high scores are better/ may be best scored electronically
Obtained
http://www.bodytechniques.com/pdf/Health%20Survey.pdf
Instrument
SF-12
Description
SELF REPORT QUESTIONNAIRE
The SF-12 is a generic Quality of Life instrument uses a subset of 12 items from the SF-36:
general health perception, physical function, physical role, bodily pain, social functioning,
mental health, emotional role, vitality, change in health & a global summary score.
Feasibility
Patient Burden
o Contains items of importance to patients: see above
o Comfort and convenience to patients: can be done by phone or web/ simple
wording/ has been translated into numerous languages
o Time to administer: 10 minutes
Clinician Burden
o Cost: ?likely to be similar to SF-36
o Training required: some training required on scoring/ there is a manual & online
scoring service (at a cost?)
o Ease of scoring & interpretation of results: requires around 7 minutes to score/
normative data available/ some items are reverse scored/ somewhat complex scoring
method (less complex than SF-36)/ high scores are better/ may be best scored
electronically
o The minimum possible score is 0 and the maximum possible score is 100
Obtained
http://www.tcjr.com/forms/SF12form.pdf
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Brief Pain Inventory
Description
SELF REPORT QUESTIONNAIRE
BPI asks patients to rate on 0-10 scales their current pain intensity & also pain in the last 24
hours, at its worst, least and average. Patients then rate (0-10) the extent to which their pain
interferes with: general activity, walking, mood, sleep, work, relations with other persons,
enjoyment of life. There are11 questions in total.
Feasibility
Patient Burden
o Contains items of importance to patients: see above
o Comfort and convenience to patients: simple wording/ circle number on scale/ could
be done by phone or web/ has been translated into several languages
o Time to administer: 5 minutes to complete
Clinician Burden
o Cost: free/ no licence
o Training required: no formal training required
o Ease of scoring & interpretation of results: pain & interference are scored &
summed separately / lower scores are better
Obtained
http://www.mdanderson.org/education-and-research/departments-programs-andlabs/departments-and-divisions/symptom-research/symptom-assessment-tools/bpisf.pdf
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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OCCUPATIONAL RISK FACTORS FOR LOW BACK PAIN
Instrument
Obstacles to Return to Work Questionnaire (ORTWQ)
Description
SELF REPORT QUESTIONNAIRE
A 55 item self-report questionnaire for assessing psychosocial factors related to work that
could be barriers to return to work (RTW) amongst individuals with chronic
musculoskeletal pain (shoulder, neck, low back). It measures: pain intensity & depression;
work demands, support, satisfaction, sick leave worry, difficulties at RTW; & family
support; perceived prognosis of work return.
Each question is assessed on a 7 point Likert scale (0-6) with text at both ends (do not agree
at all – agree completely).
Feasibility
Respondent Burden:
o Contains items of importance to patients: see above/ not tested in UK population
o Comfort and convenience to patients: some readability issues/ 13 reverse question
wording can be difficult to understand/ could be done by web/ convenience depends
on setting.
o Time to administer: around 20 minutes.
Clinician Burden:
o Cost: In the public domain with no cost.
o Training required: no formal training required
o Ease of scoring & interpretation of results:
o Scores can be summed manually. 13 scores have to be inverted.
o Overall scores range from 0 to 330. Cut off scores are provided.
o Cut off score table requires careful interpretation.
o Lower scores = less sick leave predicted.
Obtained
Dr Steven Linton - steven.linton@oru.se
Marhold, C., Linton, S.J. & Melin, L. 2002. Identification of obstacles for chronic pain
patients to return to work: evaluation of a questionnaire. Journal of Occupational
Rehabilitation, 12(2), 65-75.
www.springerlink.com/content/fulltext.pdf?id=doi:10.1023/A:1015056429505 (pg 70-71)
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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LOW BACK PAIN
Instrument
Oswestry Disability Index
Description
SELF REPORT QUESTIONNAIRE
Questionnaire 10 sections that refer to activities of daily living that might be disrupted by
low back pain. One statement in each section is chosen that most accurately describes
limitation of function in that activity.
Each section scale of 0-5, where 5 represents the greatest disability. Total possible score of
50. Score 0-100
Patient Burden
o Contains items of importance to patients: yes
o Comfort and convenience to patients: 10 sections x 6 questions (one section out of
the 10 asks questions about sex life)
o Time to administer: 5-6 minutes
o Available in many languages
Clinician Burden
o Cost: free one A4 sheet
o Training required: none
o Ease of scoring & interpretation of results: takes 1 minute to score
o Available guides on minimal clinically important differences (MCID)
Feasibility
Obtained
www.tac.vic.gov.au/upload/Oswestry.pdf
Instrument
Roland and Morris Disability Questionnaire (24 item)
Description
SELF REPORT QUESTIONNAIRE
Original 24 item. Each item is rated yes/no.
The total range is 0 (lowest disability level - no pain and normal function) to 24 (highest
disability level - severe pain and dysfunction).
Patient Burden
o Contains items of importance to patients: Derived from patients
o Comfort and convenience to patients: Simple self complete questionnaire with 24
questions
o Time to administer: 2-3 minutes
o Available in most languages
Clinician Burden
o Cost: free - one A4 sheet of paper
o Training required: No training required
o Ease of scoring & interpretation of results: Simple to score
o Available guides on minimal clinically important differences (MCID)
Feasibility
Obtained
www.rmdq.org/Download.htm
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Tampa Scale of Kinesiophobia
Description
SELF REPORT QUESTIONNAIRE
17 item questionnaire measuring fear of movement or re-injury. Each item has a 4 point
Likert scale (1=strongly disagree to 4=strongly agree). There are 4 reverse-scored items.
Total score from 17=no fear to 68=strong fear avoidance beliefs
Feasibility
Patient Burden
o Contains items of importance to patients: Measures fear of movement
o Comfort and convenience to patients: Self complete questionnaire and involves
graduated scale (1-4) with some reverse scoring so requires concentration on the
actual questions
o Time to administer: 5 minutes
Clinician Burden
o Cost: free
o Training required: Some training required in social / psychological questioning
techniques
o Ease of scoring & interpretation of results: Requires some time for calculation of
total scores and interpretation
o Available guides on minimal clinically important differences (MCID)
Obtained
www.medicalpanels.vic.gov.au/wps/wcm/connect/9b57dc004071f90694b8dee1fb554c40/tampa
_scale_kinesiophobia.pdf?MOD=AJPERES
HIP AND KNEE
Instrument
Western Ontario McMaster Universities Osteoarthritis Index (WOMAC)
Description
SELF REPORT QUESTIONNAIRE
A self-assessed disease specific measure for patients with OA of the knee and hip,
comprising 24 items in three dimensions: pain (5 items), function (17items) and stiffness (2
items)
Patient Burden
o Contains items of importance to patients: pain, function and stiffness
o Comfort and convenience to patients: 24 item self-administered questionnaire
o Time to administer: 5 to 7 minutes
Clinician Burden
o Cost: Approximately: £400
o Training required: does not require specific training
o Ease of scoring & interpretation of results: cumulative totals
Feasibility
Obtained
www.orthopaedicscore.com/scorepages/knee_injury_osteopaedic_outcome_score_womac.html
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Timed Get Up and Go (TUG) Test
Description
The timed get up and go test is a measurement of mobility. It includes a number of tasks
such as standing from a seating position, walking, turning, stopping, and sitting down. The
person is asked to stand up from a standard chair and walk a distance of approximately 10
feet, turn around and walk back to the chair and sit down again.
Patient Burden
o Contains items of importance to patients: common functional task
o Comfort and convenience to patients: patient in control of test
o Time to administer: 5 minutes
Clinician Burden
o Cost: nil
o Training required: minimal training required
o Ease of scoring & interpretation of results: timed test
Feasibility
Obtained
www.fallpreventiontaskforce.org/pdf/TimedUpandGoTest.pdf
Instrument
Lysholm Knee Scale
Description
SELF REPORT QUESTIONNAIRE
A condition-specific questionnaire containing 8 domains: limp (5 points), locking (15
points), pain (25 points), stair-climbing (10 points), support (5 points) , instability (25
points) , swelling (10 points) and squatting (5 points). 8 items, 3 - 6 response options,
different weightings adding to 100.
Feasibility
Patient Burden
o Contains items of importance to patients: limp, pain, locking, instability, support,
squatting
o Comfort and convenience to patients: self administered questionnaire
o Time to administer: 5 minutes
Clinician Burden
o Cost: nil
o Training required: no training required
o Ease of scoring & interpretation of results: score out of 100
Obtained
www.orthopaedicscore.com/scorepages/tegner_lysholm_knee.html
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Description
Feasibility
Patellofemoral Pain Syndrome Severity Scale (PSS)
SELF REPORT QUESTIONNAIRE
Self administered instrument comprising 10 statements in which the patient rated their pain
over the past week while performing various activities: climbing stairs, squatting, walking,
jogging, sprinting, participating in sport, sitting with knees bent, kneeling of knees, pain at
rest/sleeping, pain while resting following activity.
Patient Burden
o Contains items of importance to patients: stairs, sitting, kneeling, sleeping, sports
o Comfort and convenience to patients: self administered questionnaire
o Time to administer: 5 minutes
Clinician Burden
o Cost: nil
o Training required: no training required
o Ease of scoring & interpretation of results: score out of 100
Obtained
cre.sagepub.com/cgi/reprint/16/7/780
Instrument
Western Ontario Meniscal Evaluation Tool (WOMET)
Description
Self administered questionnaire with 16 items covering 3 domains: physical symptom (9
items); sports, recreation, work, and lifestyle (4 items); emotions (4 items).
Feasibility
Patient Burden
o Contains items of importance to patients: pain, sports, recreation, work, emotion
o Comfort and convenience to patients: self administered questionnaire
o Time to administer: 5 minutes
Clinician Burden
o Cost: nil
o Training required: no training required
o Ease of scoring & interpretation of results: score out of 1600 expressed as a
percentage
Obtained
Unavailable
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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FOOT AND ANKLE
Instrument
Foot and Ankle Ability Measure (FAAM)
Description
SELF REPORT QUESTIONNAIRE
Comprises the separately scored 21-item ADL and 8-item sports subscales. Each item is
scored on a 5-point Likert scale anchored by 4 (no difficulty at all) and 0 (unable to do).
Item score totals, which range from 0 to 84 for the ADL subscale and from 0 to 32 for the
sports subscale, are transformed to percentage scores. A higher score represents a higher
level of function for each subscale
Patient Burden
o Contains items of importance to patients: It outlines the importance of daily living
o Comfort and convenience to patients: The construction of the questionnaire would
seem to be easily understood.
o Time to administer: up to 5 mins
Clinician Burden
o Cost:
o Training required: just an explanation of how to fill out the questionnaire
o Ease of scoring & interpretation of results: no difficulty
Feasibility
Obtained
www.udel.edu/PT/PT%20Clinical%20Services/journalclub/sojc/06_07/Feb07/AbilityMeasure.pdf
Instrument
Manchester Foot Pain and Disability Index
Description
SELF REPORT QUESTIONNAIRE
17 statements prefaced by 'because of pain in my feet'. 3 constructs; functional limitations
(10 items), pain intensity (5 items), personal appearance (2 items). Each of the 17 items:
none of the time (score=0); some days (score=1); on most days/every day (score=2). The
total MFPDI score therefore ranges from a minimum of 0 to a maximum possible score of
34.
Patient Burden
o Contains items of importance to patients: includes items of function, pain and
personal appearance.
o Comfort and convenience to patients: Tick boxes
o Time to administer: under 5 mins
Clinician Burden
o Cost: unclear
o Training required: would require simple explanation to user
o Ease of scoring & interpretation of results: no difficulty
Feasibility
Obtained
download.journals.elsevierhealth.com/pdfs/journals/0304-3959/PIIS0304395999002638.pdf
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Description
Feasibility
Obtained
American Academy of Orthopaedic Surgeons Lower limb Outcomes Assessment
Instrument
SELF REPORT QUESTIONNAIRE
The Foot and Ankle Module, contains two scales the Global Foot and Ankle Scale (twenty
items and four subscales measuring pain, function, stiffness and swelling, and giving way)
and the Shoe Comfort Scale (five items)
Patient Burden
o Contains items of importance to patients: pain, function, stiffness and swelling, and
giving way
o Comfort and convenience to patients: Fairly easy to read and understand
o Time to administer: unclear
Clinician Burden
o Cost: unclear
o Training required: simple explanation
o Ease of scoring & interpretation of results:
www.aaos.org/research/outcomes/Foot_Ankle.pdf
SHOULDER
Instrument
Description
Feasibility
Obtained
American Shoulder and Elbow Surgeons (ASES) Subjective Shoulder Scale
SELF REPORT QUESTIONNAIRE
Pain intensity (0-10 points), refers to today
Function: 10 items of daily living (4-point scale): left & right separately
Widely used for outcomes assessment in patients with shoulder instability, rotator cuff
disease, and glenohumeral arthritis.
Pain accounts for 50% of the overall ASES score. Function accounts for the other 50% of
the overall score. Formula to compute final score.
Patient Burden
o Contains items of importance to patients: pain & aspects of ADL
o Comfort and convenience to patients: paper-based, self-report, some items may be
difficult to interpret
o Time to administer: evidence suggests 10 minutes
Clinician Burden
o Cost: none (paper & time to administer)
o Training required: instructions regarding items & scoring
o Ease of scoring & interpretation of results: requires calculation
Applicability: clinic, phone, online, postal
http://pt.umaryland.edu/clinical_education/docs/outcome_tools/ASES_Shoulder_Assessment_Fo
rm_JSES.pdf
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Disability of Arm, Shoulder and Hand (DASH or quick DASH)
Description
SELF REPORT QUESTIONNAIRE
DASH 30-items, each item scored on a 5-point scale, refers to past week
Quick-Dash: 11-items + optional work and sports & arts modules
Pain, function, participation in work, sports, arts & other activities
Scoring is done by summing up the circled responses and subtracting 30. Formula to obtain
a final score out of a possible 100
Guidelines for missing responses are provided. If responses to more than three items are
missing, the overall score cannot be calculated.
May be less suitable for patients with more severe shoulder problems
Patient Burden
o Contains items of importance to patients: pain, aspects of ADL, participation in
work and other social activities
o Comfort and convenience to patients: paper-based, self-report
o Time to administer: approximately 10 minutes
Clinician Burden
o Cost: licence needed? (paper & time to administer)
o Training required: instructions regarding items & scoring
o Ease of scoring & interpretation of results: requires calculation
Applicability: clinic, phone, online, postal
Feasibility
Obtained
http://www.orthopaedicscore.com/scorepages/disabilities_of_arm_shoulder_hand_score_quickd
ash.html
Instrument
Shoulder Pain and Disability Index (SPADI)
Description
SELF REPORT QUESTIONNAIRE
SPADI is a 13 item questionnaire. The pain domain consists of five questions and the
disability domain consists of eight.
Questions refer to the past week
Visual analogue scale (VAS) or 0-10 point rating scale.
Formula to obtain a score for pain, function, or a total score
Patient Burden
o Contains items of importance to patients: pain, aspects of ADL
o Comfort and convenience to patients: paper-based, self-report, one item may be
difficult to interpret
o Time to administer: less than 10 minutes
Clinician Burden
o Cost: none (paper & time to administer)
o Training required: instructions regarding items & scoring
o Ease of scoring & interpretation of results: requires calculation
Applicability: clinic, phone, online, postal
Feasibility
Obtained
www.tac.vic.gov.au/upload/SPI.pdf
SCOTTISH MINIMUM DATA SET FOR COMMUNITY BASED MUSCULOSKELETAL REHABILITATION
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Instrument
Oxford Shoulder Score
Description
SELF REPORT QUESTIONNAIRE
1 scale (12 items) on pain and function
Each item scored on 5-point scale (0-4), total score ranges between 0 and 48
Reference period: 4 weeks
Designed for secondary care populations: may be less useful in primary care  more
difficult to demonstrate change in people with less severe shoulder problems
Feasibility
Patient Burden
o Contains items of importance to patients: pain and aspects of ADL
o Comfort and convenience to patients: paper-based, self-report questionnaire
o Time to administer: less than 10 minutes
Clinician Burden
o Cost: none (paper & time to administer)
o Training required: little needed
o Ease of scoring & interpretation of results: addition of item scores only
Applicability: clinic, phone, online, postal
Obtained
http://www.orthopaedicscore.com/scorepages/oxford_shoulder_score.html