A Comparison of Three Low Back Disability Questionnaires With Rasch Analysis

라쉬분석을 이용한 세 가지 요통 장애 설문지의 비교

  • Kim, Gyoung-Mo (Dept. of Rehabilitation Therapy, The Graduate School, Yonsei University) ;
  • Park, So-Yeon (Dept. of Physical Therapy, College of Alternative Medicine, Jeonju University) ;
  • Yi, Chung-Hwi (Dept. of Physical Therapy, College of Health Science, Yonsei University, Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University)
  • 김경모 (연세대학교 대학원 재활학과) ;
  • 박소연 (전주대학교 대체의학대학 물리치료학과) ;
  • 이충휘 (연세대학교 보건과학대학 물리치료학과, 보건환경대학원 인간공학치료학과)
  • Received : 2011.06.22
  • Accepted : 2011.08.05
  • Published : 2011.09.17


The purpose of this study was to review existing assessment tools for patients with low back pain and improve them through combination. A total of 314 patients with low back pain participated. Their condition was assessed using the Oswestry Disability Questionnaire (ODQ), the Quebec Back Pain Disability Scale (QBPD), and the Back Pain Functional Scale (BPFS). Rasch analysis was applied to identify inappropriate items, item difficulties, and the separation index. In this study, the 'sex life' item of the ODQ (10 items) and the 'sleeping' item of the BPFS (12 items) showed misfit statistics, whereas all items of the QBPD (20 items) were appropriate. After combining the ODQ, QBPD and BPFS, Rasch analysis was applied. The 'pain intensity', and the 'sex life' item of the ODQ and the 'throw a ball' item of QBPD showed misfit statistics. These 3 items were retained for further analysis. The remaining 42 combined ODQ-QBPD-BPFS items were arranged according to difficulty. For all subjects, the most difficult item was 'pain intensity', whereas the easiest was 'take food out of the refrigerator'. As the separation index of 42 combined ODQ-QBPD-BPFS was higher than that of the three questionnaires separately, difficulty of items varied with some need for rearrangement. The results of this study confirmed the possibility and need for a new back pain disability assessment tool, and produced one. Further study is needed to refine the questionnaire in consideration of psychosocial and occupational factors.



  1. 김경모, 박소연, 이충휘. 요통 환자의 일반적 특성에 따른 한국어판 오스웨스트리 장애 설문지의 라쉬분석. 한구전문물리치료학회지. 2011;18(2):35-42.
  2. 박소연. 노인에 낙상에 영향을 주는 요인을 평가하기 위한 ABC-BBS의 적용: 사전연구. 한국전문물리치료학회지. 2008;15(2):44-53.
  3. 박소연, 오재섭, 이충휘. 수정된 오스웨스트리 허리기능 장애 설문지의 라쉬분석: 산업장에서의 업무관련 요통환자를 대상으로. 한국전문물리치료학회지. 2008;15(3):26-34.
  4. 성태제. 현대교육평가 3판. 서울, 학지사, 2010.
  5. 이충휘. 물리치료사와 작업치료사를 위한 연구방법론 3판. 서울, 계축문화사, 2007.
  6. 전창훈, 김동재, 김동준 등. 한국어판 Oswestry Disability Index(장애지수)의 문화적 개작. 대한척추외과학회지. 2005;12(2):146-152.
  7. 지은림, 채선희. 라쉬모형의 이론과 실제. 서울, 교육과학사, 2000.
  8. Beattie P, Maher C. The role of functional status questionnaires for low back pain. Aust J Physiother. 1997;43(1):29-38. https://doi.org/10.1016/S0004-9514(14)60400-1
  9. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: Summary and general recommendations. Spine (Phila Pa 1976). 2000;25(24):3100-3103. https://doi.org/10.1097/00007632-200012150-00003
  10. Boos N, Rieder R, Schade V, et al. 1995. Volvo award in clinical science. The diagnostic accuracy of magnetic resonance imaging, work perception and psychosocial factors in identifying symptomatic disk herniations. Spine (Phila Pa 1976). 1995;20(24):2613-2625. https://doi.org/10.1097/00007632-199512150-00002
  11. Chou R, Fu R, Carrino JA, et al. Imaging strategies for low-back pain: Systematic review and meta-analysis. Lancet. 2009;373(9662):463-472. https://doi.org/10.1016/S0140-6736(09)60172-0
  12. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and man-agement of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. https://doi.org/10.1016/j.spinee.2010.03.032
  13. Dallmeijer AJ, Dekker J, Roorda LD, et al. Differential item functioning of the functional independence measure in higher performing neurological patients. J Rehabil Med. 2005;37(6):346-352. https://doi.org/10.1080/16501970510038284
  14. Davidson M, Rasch analysis of three versions of the Oswestry Disability Questionnaire. Man Ther. 2008;13(3):222-231. https://doi.org/10.1016/j.math.2007.01.008
  15. Davidson M, Keating JL. A comparison of five low back disability questionnaires: Reliability and responsiveness. Phys Ther. 2002;82(1):8-24.
  16. Delitto A. Are measures of function and disability important in low back care? Phys Ther. 1994;74(5):452-462. https://doi.org/10.1093/ptj/74.5.452
  17. Fairbank JC, Couper J, Davies JB. et al. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-273.
  18. Grotle M, Brox JL, Vollestad NK, Functional status and disability questionnaire: What do they assess? A systematic review of back-specific outcome questionnaires. Spine (Phila Pa 1976). 2005;30(1):130-140. https://doi.org/10.1097/01.brs.0000149184.16509.73
  19. Haywood KL. Patient reported outcome I: Measuring what matters in musculoskeletal care. Musculoskeletal Care. 2006;4(4):187-203. https://doi.org/10.1002/msc.94
  20. Holm I, Friis A, Storheim K, et al. Measuring self-reported functional status and pain in patients with chronic low' back pain by postal questionnaires. Spine (Phila Pa 1976). 2003;28(8):828-833.
  21. Kopec JA, Esdaile JM, Abrahamowicz M, et al. The Quebec Back Pain Disability Scale: Measurement properties. Spine (Phila Pa 1976). 1995;20(3):341-352. https://doi.org/10.1097/00007632-199502000-00016
  22. Lewis JS, Hewitt JS, Billington L, et al. A randomized control trial comparing two physiotherapy intervention for chronic low back pain. Spine (Phila Pa 1976). 2005;30(7):711-721. https://doi.org/10.1097/01.brs.0000157469.27779.de
  23. Modic MT, Obuchowski NA, Ross JS, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 2005;237(2):597-604. https://doi.org/10.1148/radiol.2372041509
  24. Rocchi MB, Sisti D, Benedetti P, et al. Critical comparison of nine different self-administered questionnaires for the evaluation of disability caused by low back pain. Eura Medicophys. 2005;41(4):275-281.
  25. Roland M, Morris R. 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). 1983;8(2):141-144. https://doi.org/10.1097/00007632-198303000-00004
  26. Stratford PW, Binkley JM, Riddle DL. Development and initial validation of the Back Pain Functional Scale. Spine (Phila Pa 1976). 2000;25(16):2095-2102. https://doi.org/10.1097/00007632-200008150-00015
  27. Waddell G. The Back Pain Revolution. Edinburgh, Churchill Livingstone, 1998.
  28. Waddell G, Main CJ. Assessment of severity in low-back disorders. Spine (Phila Pa 1976). 1984;9(2):204-208. https://doi.org/10.1097/00007632-198403000-00012