Low Back Pain Rating Scale

Last Updated

November 10, 2017

Purpose

Monitors low back pain outcomes and includes 21 self-reported items and 4 performance-based measures, covering 3 clinical illness domains: back and leg pain, disability, and physical impairment.

Link to Instrument

Instrument Details

Acronym LBPRS

Area of Assessment

Pain

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Back Pain

Includes both self-reported and performance-based measures
Higher scores reflect a greater level of disability and impairment
Item-level scores are assigned for 3 domains:
1) back and leg pain (0-60 points)
2) disability (0-30 points)
3) physical impairment (0-40 points)
Pain Assessment Index:
6 11-point scales, where 0 = “no pain” and 10 = “worst imaginable pain”
Disability Index:
15 questions scored 0 to 2 where 0 = “not a problem”, 1 = “can be a problem”, and 2 = “is a problem.”
Physical Impairment:
4 measures of physical impairment (each scored 0-10) which are endurance of back muscles, back mobility, overall mobility, and the use of analgesics.
Each of the 3 domains is scored separately; the total score represents a sum of all 3 domains.
The 3 domains form a rank scale in which an asymptomatic individual scores 0 and a person with extreme disability scores 130.

Number of Items

21 self-reported

4 performance-based

Bench
Strap
Measuring tape
Marker
Flat couch (80 cm above the floor)

15-20 minutes

Required Training

No Training

Instrument Reviewers

Joshua White, MPT, ATC, MTC

ICF Domain

Body Function
Activity
Environment

Considerations

A modified version of the questionnaire, omitting the physical impairment items, has been developed for mail or phone interviews.
It is recommended not to use the total sum score as sub-scores from the 3 domains provide valuable information and are not influenced by weighting bias (Muller, Duetz, Roeder, & Greenough, 2004).
The scale is available in Danish, English, Turkish, German, and Polish. The test has been validated in Danish.
The data presented reflects the MCID of the Danish version of the scale.

Minimally Clinically Important Difference (MCID)

Low Back Pain: (Lauridsen, Hartvigsen, Manniche, Korsholm, & Grunnet-Nilsson, 2006; n = 191 participants with low back pain and/or leg pain, mean age = 44-47; the data presented reflect the MCID of the Danish version)

10 points for pain component
17 points for disability component
Inconclusive data for physical impairment component

	All LBP Patients (n = 191)	Outpatient Hospital Clinic LBP Patients (n = 94)	Chiropractic Clinic LBP Patients (n = 97)
MCID: (LBPRS – Pain)	10	20	13
MCID: (LBPRS – Disability)	17	17	17
MCID: (LBPRS – Impairment)	No Data	No Data	No Data

Low Back Pain (Chiropractic Clinic): (Lauridsen et al., 2006; n = 94 participants with low back pain and/or leg pain within the primary sector; mean age = 44)

20 for pain component
17 for disability component
Inconclusive data for physical impairment component

Low Back Pain (Outpatient Hospital Clinic): (Lauridsen et al., 2006; n = 97 participants with low back pain and/or leg pain who had not responded to treatment in the primary sector; mean age = 47)

13 points for pain component
17 points for disability component
Inconclusive data for physical impairment component

Low Back Pain Only: (Lauridsen et al., 2006; N = 104; n = 75 participants with low back pain in the primary sector (Chiropractic Clinic), mean age = 44 (18-76) years; n = 29 participants with low back pain who had not responded to treatment in the primary sector (Outpatient Hospital Clinic))

12 points for pain component
17 points for disability component
Inconclusive data for physical impairment component

Low Back Pain +/- Leg Pain: (Lauridsen et al., 2006; N = 104; n = 75 participants with low back pain and/or leg pain within the primary sector (Chiropractic Clinic), mean age = 44 (18-76) years; n = 29 participants with low back pain and/or leg pain who had not responded to treatment in the primary sector (Outpatient Hospital Clinic))

17 points for pain component
17 points for disability component
Inconclusive data for physical impairment component

Normative Data

Low Back Pain: (Lauridsen et al., 2006)

Low Back Pain Only
- Mean (SD) Low Back Pain Rating Scale (LBPRS) score for disability component = 0.8, range = 0.4 to 1.3
- Mean (SD) Low Back Pain Rating Scale (LBPRS) score for pain component = 1.3, range = 1.0 to 1.6
Low Back and Leg Pain
- Mean (SD) Low Back Pain Rating Scale (LBPRS) score for disability component = 0.8, range = 0.3 to 1.2
- Mean (SD) Low Back Pain Rating Scale (LBPRS) score for pain component = 1.3, range = 0.7 to 1.9

Interrater/Intrarater Reliability

Low Back Pain: (Manniche et al., 1994; n = 58)

Excellent interrater reliability: (ICC = 0.98)

Internal Consistency

Low Back Pain: (Lauridsen et al., 2006)

Excellent for sub-scores: Cronbach's alpha = 0.89 to 0.95
Excellent for total scores: Cronbach's alpha = 0.96

Criterion Validity (Predictive/Concurrent)

Low Back Pain: (Christensen et al., 1993; n = 58 patients with severe low back pain; mean age = 14 to 60 months after surgery)

Excellent correlations with Oswestry Disability Index (ODI) at 18 months after therapy (r = 0.82); Authors were unable to establish the values of the two outcome measures

Excellent correlation with German version of Roland-Morris Disability Questionnaire (RMDQ) (r = 0.91, p < 0.001)

Construct Validity

Low Back Pain: (Maniche et al., 1993; n = 261; mean age = 51)

Excellent correlation between LBPRS and Patient’s Global Assessment (r = .97)
Excellent correlation between LBPRS and Doctor’s Global Assessment (r = .93)

Content Validity

Low Back Pain: (Nuhr, Crevenna, Quittan, Auterith, Wiesinger, Brockow, & Ebenbichler, 2004; n = 126 patients with low back pain from all German speaking countries in Europe; mean age = 60, range of 20-87 years old).

Excellent correlation (r = 0.91, p < 0.001) between the German version of the LBPRS and the Roland-Morris Disability Questionnaire (RMDQ) (Nuhr et al., 2004; Smeets, Köke, Lin, Ferreira, & Demoulin, 2011)

Responsiveness

Low Back Pain: (Kalidindi, Patro, & Sharma, 2016; n = 172 patients with chronic low back pain presenting to tertiary care center in India; aged 18-65; follow up at 3 and 6 months after common rehabilitation and analgesic protocol)

Excellent with no floor and ceiling noted for LBPRS scores in various categories (local LBP only, LBP + pain above knee, LBP + pain below knee, BLP with signs of nerve root involvement) at both 3 and 6 months

Low Back Pain: Specific Patient Population Identified Below; (Lauridsen et al., 2006)

Patients reporting an “important improvement” and “no change” groups were compared. The Standardized Response Mean (SRM) calculations are reported below:

Primary Sector (n=62)	N Value	Important Improvement SRM_raw(95% CI)	No Change SRM_RAW(95% CI)
Chiropractic Clinic LBPRS - Disability	n = 62	0.8 (0.4-1.2)	0.5 (0.1-0.9)
Chiropractic Clinic LBPRS - Pain	n = 62	1.4 (1.1-1.6)	0.6 (0.1-1.1)
Outpatient Hospital Clinic LBPRS - Disability	n = 19	0.8 (0.4-1.3)	0.3 (0.0-0.6)
Outpatient Hospital Clinic LBPRS - Pain	n = 18	1.1 (0.3-1.8)	0.3 (-0.1-0.5)
Low Back Pain Only LBPRS – Disability	n = 57	0.8 (0.4-1.3)	0.5 (0.0-1.0)
Low Back Pain Only LBPRS – Pain	n = 57	1.3 (1.0-1.6)	0.5 (0.0-1.0)
Low Back Pain +/- Leg Pain LBPRS - Disability	n = 24	0.8 (0.3-1.2)	0.3 (0.0-0.7)
Low Back Pain +/- Leg Pain LBPRS - Pain	n = 23	1.3 (0.7-1.9)	0.3 (0.0-0.6)

Bibliography

Christensen, T. H., Bliddal, H., Hansen, S. E., Jensen, E. M., Jensen, H., Jensen, R., & Bay, H. (1993). Severe low-back pain. I: Clinical assessment of two weeks conservative therapy. Scandinavian Journal of Rheumatology, 22(1), 25-29. Find it on PubMed

Kalidindi, K. K. V., Patro, D. K., & Sharma, D. (2016). Significance of sub grouping patients with chronic low back pain in management decisions: A prospective study. International Journal of Orthopedic Sciences, 2(4c), 171-175. Find it on ResearchGate

Lauridsen, H. H., Hartvigsen, J., Manniche, C., Korsholm, L., & Grunnet-Nilsson, N. (2006). Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients. BMC Musculoskeletal Disorders, 7, 82. Find it on PubMed

Manniche, C., Asmussen, K., Lauritsen, B., Vinterberg, H., Kreiner, S., & Jordan, A. (1994). Low Back Pain Rating Scale: Validation of a tool for assessment of low back pain. Pain, 57(3), 317-326. Find it on PubMed

Muller, U., Duetz, M. S., Roeder, C., & Greenough, C. G. (2004). Condition-specific outcome measures for low back pain. Part I: Validation. European Spine Journal, 13(4), 301-313. Find it on Pubmed

Muller, U., Roeder, C., Dubs, L., Duetz, M. S., & Greenough, C. G. (2004). Condition-specific outcome measures for low back pain. Part II: scale construction. European Spine Journal, 13(4), 314-324. Find it on PubMed

Nuhr, M., Crevenna, R., Quittan, M., Auterith, A., Wiesinger, G., Brockow, T., & ... Ebenbichler, G. (2004). Cross-cultural adaption of the manniche questionnaire for german-speaking low back pain patients. Journal of Rehabilitation Medicine, 36(6), 267-272. Find it on PubMed

Smeets, R., Köke, A., Lin, C. W., Ferreira, M., & Demoulin, C. (2011). Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care & Research, 63(Suppl 11), S158-173. Find it on PubMed