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RehabMeasures Instrument

Roland-Morris Disability Questionnaire

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Purpose

The RMDQ measures disability in patients with low-back pain.

Link to Instrument

Instrument Details

Acronym RMDQ

Area of Assessment

Activities of Daily Living
Functional Mobility
Pain

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Pain Management

Populations

Key Descriptions

  • The Roland-Morris is a 24-item self-report questionnaire about how low-back pain affects functional activities.
  • Each question is worth one point so scores can range from 0 (no disability) to 24 (severe disability).
  • The original questionnaire and all translations are in the public domain.
  • Permission is not required for their use or reproduction and there is no charge associated with its use.
  • There are 36 translations and adaptations available, including minor adaptations for U.S., Canadian ?and Australian English.
  • The RMDQ is scored by adding up the number of items the patient checks.
  • The score can range from 0 to 24 on the original version, but there are also versions with 18 or 21 possible points.

Number of Items

24

Equipment Required

  • Questionnaire
  • Writing implement

Time to Administer

5 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, PhD in 2012. Later updated by Sabina Beckler, SPT, Elizabeth Burnette, SPT, Cara Hehn, SPT, Mae Langford, SPT, Reid Medlin, SPT, Bryan Mull, SPT, Jessica Skeeter, SPT in November 2013. 

Body Part

Back

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion
General Health
Sensory

Considerations

Stratford & Colleagues caution that assessing improvements in patients with an initial score lower then 4 points or decreases in with initial scores greater than 20 can not be reliably detected (1996).

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Back Pain

back to Populations

Standard Error of Measurement (SEM)

Post Lumbar Disc Surgery:

(Ostelo, 2004; = 97; mean age=43.3 (8.8); 6 weeks post surgery; questionnaires completed before and after three months of treatment) 

  • SEM = 2.0 (1.5-2.9) scale points (95% CI) 

 

Outpatients with low back pain diagnosed with a musculoskeletal origin:

(Stratford et al, 1996; n = 60; mean age=41 (12); questionnaires given at initial evaluation and four and six week follow-ups.)

  • SEM = 1.79 

Participants classified: as unchanged (Davidson et al, 2002, version = RMDQ-24)

  • "Unchanged" (n = 47): SEM (95% CI) = 3.7 (2.9–4.6)
  • "About the same" (n = 16) SEM (95% CI) = 4.1 (2.7–5.6)

Minimal Detectable Change (MDC)

Post Lumbar Disc Surgery:

(Ostelo, 2004) 

  • MDC = 5.4 (4.2-8.0) scale points (95% CI)

 

Chronic Low Back Pain: (Dutch version) 

(Brouwer et al, 2004; n = 30, mean age=40 (8.1); The duration of pain was between 5-10 years; questionnaire was filled out before beginning therapy and at two weeks follow-up) 

  • MDC = 5.4 (95% CI)

 

Outpatients with low back pain diagnosed with a musculoskeletal origin:

(Stratford et al, 1996) 

  • MDC = 5 points at 95% CI for scores located in the central portion of the scale. (4 RMQ points are required to detect improvement in patients with initial scores of 4-11 RMQ points and in patients with scores greater than 16 points.) 

 

Outpatients with low back pain diagnosed with a musculoskeletal origin:

(Stratford et al, 1996) 

  • The Journal of the American Physical Therapy Association found that the MDC for the two groups study found that 8.6 or 9.5 point was needed based on the reliability estimates for these groups.

 

Chronic and Acute Low Back Pain: (Italian version) 

(Monticone et al, 2012; n = 179; mean age=47.7 (12.3); patients had a median duration of pain of 6 months; questionnaires were administered at the beginning and end of eight weeks of rehabilitation.) 

  • MDC = 4.87 

Participants classified as Unchanged  (Davidson et al, 2002)

  • "Unchanged" (n = 47) MDC (95% CI) = 8.6 (6.7–10.6)
  • "About the same" (n = 16) MDC (95% CI) = 9.5 (6.3–13)

Minimally Clinically Important Difference (MCID)

Subjects seeking treatment for low back pain from general practitioner:

(Jordan et al, 2006; n = 443; mean age=46.8 (8.12); questionnaires at consultation and 6 months later.) 

  • 30% of baseline score is considered the cut-off point for detecting change, or 3 point change. 
  • If the patient has a score of greater than 7, then the MCID = 3 points. 
  • If the score is less than 7, then the MCID = 30% change in score. 

 

Subjects seeking treatment for low back pain from general practitioner:

(Jordan et al, 2006) 

  • A change of 5 points has been recommended as the smallest change that is important for patients with low back pain after 3-6 weeks of treatment using global change or treatment goals as the reference standard.

 

 

Patients with lower back pain: (Stratford et al, 1996; n = 226; mean age = 40 (13) years; experience of back pain <6 weeks; all participants were receiving therapy during the study; version = RMDQ-24) 

  • A change of 5 points


 

Review of prior research: (Ostelo & de Vet, 2005)

  • MCID for all types of low back pain (acute, sub acute and chronic) = 3.5 points

Cut-Off Scores

Subjects seeking treatment for low back pain from general practitioner:

(Roland and Morris, 1883, Part I; n =237; mean age= 40.6; questionnaires given at consultation, and one and four week follow-ups) 

  • Poor outcome is a score of 14 or more on the Disability Questionnaire following therapy. 

 

Post Lumbar Disc Surgery:

(Ostelo, 2004) 

  • For patients 6-weeks post lumbar disc surgery between 18 and 65 years and are limited in ADLs and have not returned to work, the cut-off score is 3.5 with a sensitivity of 94.6% and a specificity of 88.2% 

 

Chronic and Acute Low back Pain: (Italian version)

(Monticone et al, 2012) 

  • Cut-Off Score = 2.5

Normative Data

Chronic and Acute Low back Pain: (Italian version)

(Monticone et al, 2012)

  • Patients who improved: 
    • Initial: 5.69 (3.73)
    • 8 week follow-up: 1.79 (2.80) 
  • Patients who were unchanged:
    • Initial: 6.80 (4.63) 
    • 8 week follow-up: 4.64 (4.05) 

 

Post Lumbar Disc Surgery:

(Ostelo, 2004) 

  • Patients who improved: 
    • Initial: 13.0
    • 3 month follow-up: 4.3
  • Patients who were unchanged: 
    • Initial: 15.4
    • 3 month follow-up: 14.3 

 

Subjects seeking treatment for low back pain from general practitioner:

(Jordan et al, 2006) 

  • Initial 9.1 (6.37)
  • 6 month follow-up 6.6 (6.56) 

(Roland and Morris, 1883, Part II) 

  • Median score initial: 11
  • 1 week follow-up: 8
  • 4 week follow-up: 4 

 

Outpatients with low back pain diagnosed with a musculoskeletal origin:

(Stratford et al, 1996) 

  • Initial visit: 11.5
  • 4-6 weeks follow-up: 6.6

 

Chronic Low Back Pain:

(Brouwer et al, 2004) 

  • Initial visit: 13.0(4.8)
  • 2 weeks follow-up: 12.1(5.0) 

 

Patients with low back pain undergoing physical therapy:

(Davidson and Keating, 2002) 

  • Patients who were unchanged: 
    • Initial visit: 9.0 (5.2) 
    • 6 weeks later: 8.2 (5.2)
  • Patients who were improved: 
    • Initial visit: 9.5 (5.9) 
    • 6 weeks later: 3.8 (4.1)

Test/Retest Reliability

Subjects seeking treatment for low back pain from general practitioner: 

(Roland and Morris, 1883, Part I) 

  • 13/20 patients reported the same score immediately following their initial consultation and later that day. 
  • The correlation coefficient was 0.91 

 

Post Lumbar Disc Surgery:

(Ostelo, 2004) 

  • ICC = 0.74 (0.51-0.87)  

 

Outpatients with low back pain diagnosed with a musculoskeletal origin:

(Stratford et al, 1996) 

  • Less than 2 weeks: ICC = 0.91
  • 3 to 6 weeks: ICC = 0.86 

 

Chronic Low Back Pain: 

(Brouwer et al, 2004) 

  • ICC: 91 (.82-.96 with 95% CI)

 

Subjects seeking treatment for low back pain from general practitioner:

(Jordan et al, 2006) 

  • ICC: 0.83 from two week test-retest study of back pain patients.

 

Doctor Determined Mechanical Spine Problem: 

(Deyo, 1986; n = 136; mean age=38; 79% with acute back pain and 14 with pain for longer than 3 months; questionnaire at consultation and 3 week follow-up) 

  • Patients reporting they have not resumed full activities (= 47), r=.76 on the Roland Scale

Patient's with lower back pain (Davidson et al, 2002) 

  • Participants classified as either changed or unchanged (initial assessment provided at the recruitment site and followed up 6 weeks later)
    • "Unchanged" (n = 47) ICC (95% CI) = .53 (.29–.71)
    • "About the same" (n = 16) ICC (95% CI) = .42 (-.07–.75)
  • Test-retest data reported by Davidson:
    • Excellent: Same day test-retest (ICC = .91)
    • Excellent: 1 to 14 day test-retest (ICC = .93)
    • Adequate: 3 to 6 week test-retest (ICC = .86)

Interrater/Intrarater Reliability

Doctor Determined Mechanical Spine Problem:

(Deyo, 1986) 

  • Patients w/ pain rated unchanged by both patient and clinician (n = 10), r =.83 on the Roland Scale

Internal Consistency

Outpatients with low back pain diagnosed with a musculoskeletal origin: 

(Stratford et al, 1996) 

  • Previously established values of .90, .84, .89, .92  

 

Workers Compensation- Systematic Review of Outcome Measures: 

(Spanjer et a, 2011; Systematic review of 10 RCTs to determine psychometric properties of instruments used to assess functional limitations in worker’s compensation claims)

  • Cronbach’s a= 0.95

 

Patient's with lower back pain: (Mousavi 2006; mean age = 40.14 (range = 17 to 68) n = 100; average years of education = 10.8 years; Persian language sample)

  • Excellent internal consistency (Cronbach's alpha = 0.83)

Criterion Validity (Predictive/Concurrent)

Doctor Determined Mechanical Spine Problem: 

(Deyo, 1986) 

  • The Roland Scale correlated well with the physical dimension of the SIP (Sickness Impact Profile), r =.89

 

Concurrent validity of back pain scales: (Kopec et al, 1995; n = 242)

  • Excellent: RMDQ and the Quebec Back Pain Disability Scale (r= 0.77)

Construct Validity

Workers Compensation- Systematic Review of Outcome Measures:

(Spanjer et a, 2011) 

  • Good with positive correlations with the Numeric Rating Scale (NRS-101) and the SF-12 and SF-36, r = 0.70-0.85

 

Patient's with lower back pain: (Mousavi 2006; Persian language sample)

 

Discriminant validity of RMDQ & SF-36 functional domains:

 

SF-36 Functional Scale

RMDQ correlations

Physical functioning

-0.62*

Role physical

-0.45*

Bodily pain

-0.59*

General health

-0.12

Vitality

-0.32*

Mental health

-0.29*

Role emotional

-0.36*

Social functioning

-0.54*

*Correlations significant at 0.001

 

Floor/Ceiling Effects

Outpatients with low back pain diagnosed with a musculoskeletal origin: 

(Stratford et al, 1996)

  • No improvement detected for scores lower than 4
  • No decline in scores equal to 20

Responsiveness

Post Lumbar Disc Surgery: 

(Ostelo, 2004) 

  • AUC: very good 
  • Scale width (improvement/deterioration): good/good

 

Workers Compensation- Systematic Review of outcome measures:

(Spanjer et a, 2011) 

  • Moderate to large responsiveness (response mean 0.78-0.84 for improvement) 

 

Chronic and Acute Low Back Pain: (Italian version)

(Monticone et al, 2012) 

  • Responsiveness for Italian version of RMDQ ranged from 2.5 to 5 points without any significant clinical differences. 

 

Patients experiencing lower back pain: (Davidson et al, 2002

  • Standard Response Mean = 0.55 (95% CI = -0.54 to 1.64)
    ROC = .77 (95% CI = 0.68 to 0.87)

Bibliography

Davidson, M. and Keating, J. L. (2002). "A comparison of five low back disability questionnaires: reliability and responsiveness." Phys Ther 82(1): 8-24. 

Deyo, R. A. (1986). "Comparative validity of the sickness impact profile and shorter scales for functional assessment in low-back pain." Spine (Phila Pa 1976) 11(9): 951-954. 

Jordan, K., Dunn, K. M., et al. (2006). "A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain." J Clin Epidemiol 59(1): 45-52. 

Kopec, J. A., Esdaile, J. M., et al. (1995). "The Quebec Back Pain Disability Scale. Measurement properties." Spine (Phila Pa 1976) 20(3): 341-352. 

Mousavi, S. J., Parnianpour, M., et al. (2006). "The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions." Spine (Phila Pa 1976) 31(14): E454-459. 

Ostelo, R. W. and de Vet, H. C. (2005). "Clinically important outcomes in low back pain." Best Pract Res Clin Rheumatol 19(4): 593-607. 

Roland, M. and Morris, R. (1983). "A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain." Spine (Phila Pa 1976) 8(2): 141-144. 

Stratford, P. W., Binkley, J., et al. (1996). "Defining the minimum level of detectable change for the Roland-Morris questionnaire." Phys Ther 76(4): 359-365; discussion 366-358.