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Purpose The aim of this study was to investigate content validity of the International Classification of Functioning, Disability and Health (ICF) Core Sets for low back pain (LBP), by examining whether common activities reported as difficult to perform are included in the Core Sets. Methods A cross-sectional design was used. Ninety-eight patients with long-lasting back pain (>3 months) between 18 and 65 years of age were consecutively recruited from a Multidisciplinary Outpatient Spine Clinic. Difficulties with daily life and work task activities because of back pain were examined by asking the patients two questions: 1) can you specify activities that are difficult to perform because of your back pain? and 2) are there specific work tasks that you are unable to do because of your back pain? Two raters independently classified the written responses according to the ICF Core Sets' component Activities and Participation. Results Activities and work tasks were linked to 15 of 29 categories (52%) in the Comprehensive Core Set, and 9 of 12 (75%) in the Brief Core Set, and the initial agreement between the two raters in coding the answers according to the Core Sets was (83%, k = 0.80) and (93%, k = 0.9), respectively, before consensus was reached. Conclusions The Comprehensive Core Set for LBP to a large degree contains daily life and work-related activities frequently reported as difficult to perform by patients with long-lasting LBP. The categories, however, are very broad and do not provide specified descriptions of the most frequently reported activity limitations such as sitting, standing and walking. The Brief Core Set does not include categories for frequently reported activities such as pulling/pushing and leisure/recreation activities. ICF Core Sets for LBP seem suitable for obtaining a gross overview of the patients' functional limitations, but do not give sufficient information from a therapeutic point of view. Copyright © 2013 John Wiley & Sons, Ltd.

Background Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies. Purpose To examine whether the patients' global impression of change (PGIC) after rehabilitation was explained by change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution primarily by the self-reported measures. Methods A test-retest design, within a prospective cohort study of patients with long-lasting low back pain. 96 patients were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5 weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. The study was approved by the Regional Committee for Medical Research Ethics and the National Data Inspectorate of Norway. Results In unadjusted analysis, change in pain, daily functioning and change in six physical tests contributed to the explained variance (R2: 6–24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5 weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training. Conclusion Most measures demonstrated change that was of significance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients' impression of change after controlling for change in pain and daily life functioning and may seem important to assess in addition to the self-report measures in intervention studies. Copyright © 2013 John Wiley & Sons, Ltd.

STUDY DESIGN Cross-sectional and longitudinal designs within a prospective cohort study. OBJECTIVE Translation of Hannover Functional Ability Questionnaire (FFbH-R) into Norwegian and examination of its factor structure, internal consistency, reproducibility, construct validity, and responsiveness in patients with long-lasting back pain. SUMMARY OF BACKGROUND DATA Several condition-specific instruments have been developed to evaluate functional status in low back pain, but FFbH-R was the only instrument found to solely measure perceived capability of performing daily activities. METHODS Recommended guidelines for translation of questionnaires and quality criteria for validation were followed. A total of 111 patients (aged 18-65 years) with long-lasting back pain were consecutively recruited from an outpatient spine clinic. Two additional samples of patients with long-lasting back pain were added into the exploratory factor analysis, giving a total number of 224 patients. Predefined hypotheses regarding construct and longitudinal validity (responsiveness) were examined. RESULTS Factor analysis indicated that 2 items should be removed, resulting in a 3-factor solution as the best fit. The factors were related to flexibility, dynamic strength, and posture endurance. Satisfactory internal consistency and reproducibility were demonstrated for the total and subscales of the Norwegian version of FFbH-R. Most of the predefined hypothesis regarding construct and longitudinal validity were confirmed, and discriminate ability was shown. Minor floor and ceiling effects were demonstrated. CONCLUSION Psychometric properties of the Norwegian version of FFbH-R were satisfactory in patients with long-lasting back pain, but the dynamic strength and posture endurance subscales might be complemented with additional items.

Objectives: Multimodal cognitive behavior programs are found to be appropriate treatment for patients with chronic widespread pain [CWP]. The aim of this study was to investigate whether follow-up body awareness group training could cause a greater long-lasting effect and promote more patients to return to work.Methods: In a randomized controlled trial, 52 patients with CWP and more than 10 tender points were enrolled after having participated in a multimodal program. The intervention group attended a psychomotor physiotherapy group training 18 times during 1.5 years. The training started one month after the end of multimodal treatment. The control group received treatment as usual. Outcome measures were work status, Global Physiotherapeutic Examination, pain levels, and quality of life. All patients were tested within two weeks after the multimodal treatment, after 12 months, and after 18 months.Results: Improvement in test scores was demonstrated in both groups over time. However, the intervention group...

Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies.To examine whether the patients' global impression of change (PGIC) after rehabilitation was explained by change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution primarily by the self-reported measures.A test-retest design, within a prospective cohort study of patients with long-lasting low back pain. 96 patients were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5 weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. The study was approved by the Regional Committee for Medical Research Ethics and the National Data Inspectorate of Norway.In unadjusted analysis, change in pain, daily functioning and change in six physical tests contributed to the explained variance (R2: 6-24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5 weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training.Most measures demonstrated change that was of significance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients' impression of change after controlling for change in pain and daily life functioning and may seem important to assess in addition to the self-report measures in intervention studies.

The aim of this study was to investigate content validity of the International Classification of Functioning, Disability and Health (ICF) Core Sets for low back pain (LBP), by examining whether common activities reported as difficult to perform are included in the Core Sets.A cross-sectional design was used. Ninety-eight patients with long-lasting back pain (3 months) between 18 and 65 years of age were consecutively recruited from a Multidisciplinary Outpatient Spine Clinic. Difficulties with daily life and work task activities because of back pain were examined by asking the patients two questions: 1) can you specify activities that are difficult to perform because of your back pain? and 2) are there specific work tasks that you are unable to do because of your back pain? Two raters independently classified the written responses according to the ICF Core Sets' component Activities and Participation.Activities and work tasks were linked to 15 of 29 categories (52%) in the Comprehensive Core Set, and 9 of 12 (75%) in the Brief Core Set, and the initial agreement between the two raters in coding the answers according to the Core Sets was (83%, k = 0.80) and (93%, k = 0.9), respectively, before consensus was reached.The Comprehensive Core Set for LBP to a large degree contains daily life and work-related activities frequently reported as difficult to perform by patients with long-lasting LBP. The categories, however, are very broad and do not provide specified descriptions of the most frequently reported activity limitations such as sitting, standing and walking. The Brief Core Set does not include categories for frequently reported activities such as pulling/pushing and leisure/recreation activities. ICF Core Sets for LBP seem suitable for obtaining a gross overview of the patients' functional limitations, but do not give sufficient information from a therapeutic point of view.

Background. Few studies have examined the responsiveness of physical tests. Objective. The purpose of this study was to explore the responsiveness of 10 physical tests used for patients with back pain in order to illuminate the significance of changes in scores. Design. Cross-sectional and longitudinal designs within a prospective cohort study were applied. Methods. Distribution-based and anchor-based methods were used. Ninety-eight patients (18-65 years of age) with long-lasting back pain were recruited consecutively at an outpatient spine clinic. Measurements. The participants were assessed using 10 physical tests and 2 questionnaires (Hannover Functional Ability Questionnaire and Roland-Morris Disability Questionnaire) at inclusion and after rehabilitation. Six predefined hypotheses for each test were examined regarding the association between changes in scores on the physical tests and the self-report measures of functioning and regarding the relationship of changes in scores on the physical tests and external anchors of important change. Results. Five physical tests demonstrated responsiveness by both distributionbased and anchor-based methods: spondylometry, lateral flexion test, fingertip-tofloor test, lift test, and Back Performance Scale (4 hypotheses confirmed). The minimal important change values were all within the range of the smallest detectable change for individual patients. Responsiveness by distribution-based methods only (3 hypotheses confirmed) was shown for the Biering-Sørensen test and the loaded reach test, whereas little evidence of responsiveness (1 hypothesis confirmed) was shown for the Global Physiotherapy Examination flexibility subscale, the Progressive Isoinertial Lifting Evaluation, and the 15-m (50-ft) walk test. Limitations. The smallest detectable change values were examined in a small sample of patients and need further exploration. Conclusions. Responsiveness varied among the 10 physical tests.