Outcome measures, Red/yellow flags

Question 1

What are outcome measures?

Answer 1

Used to document progress
– Must demonstrate a departure from wellness
– Must demonstrate progress

Question 2

What is the importance of having documented progress?

Answer 2

Show that treatment is effective, reasonable, and necessary.

Question 3

Types of outcome measures:

Answer 3

Visual pain analog scale - no pain to worst pain imaginable
Numeric pain rating scale (NRS - circle the number) no pain to worst pain imaginable
VAS
Quadruple VAS
Pain diagram
Etc

Question 4

What is VAS and who is it best for?

Answer 4

Vertical analog scale, better understood by the elderly.

Question 5

What is quadruple VAS?

Answer 5

• Pain Right Now?
• Typical or Average Pain?
• Pain At It’s Best?
• Pain At It’s Worst?

Question 6

What is ODI?

Answer 6

Oswestry disability index.

• Low back disability
• 10 sections of daily activities
– Pain Intensity, personal care, walking, social life…
• 6 choices for each section
• Scored 0-5
• Add each section for over-all disability
– Greatest disability = 50
– or multiply by 2 for % score

Question 7

What is the Roland Morris Questionnaire?

Answer 7

• RMQ
• Low back disability
• 24 disability statements
• Score: total number of statements marked

Question 8

What is the Bournemouth low back and neck questionnaires?

Answer 8

• 7 Items
• Each is a scale of 0 to 10
• Take total points and divide by 70 for % disability

Question 9

What is the headache disability Index?

Answer 9

• 2 subscales
– Emotional and Functional
• Plus Total Composite score

Question 10

What is the upper extremity functionality index?

Answer 10

(UEFI)
– 20 Items scored 0 – 4
– Total score / 80 x 100 = % disability

Question 11

What is LEFS?

Answer 11

Lower Extremity Functional Scale (LEFS)
• Similar to Upper Extremity Functional
Index (UEFI)
– 20 Items scored 0 – 4
– Total score / 80 x 100 = % disability

Question 12

What is the general health status questionnaire?

Answer 12

Health Status Questionnaire (HSQ 36, or SF 36)
– 8 Subscales of general health
• Physical Functioning, Role Physical, Bodily Pain,
General Health, Vitality, Social Functioning, Role
Emotional, Mental Health
– 2 Summary Measures
• Physical Health, Emotional Health
– Overall score
– 3 Individual diagnostic questionaires

Question 13

***What is the global well-being scale?

Answer 13

Laid out opposite of VAS. Worst you could possibly feel is on the left, best you could possibly feel is on the right, unlike VAS.

Question 14

What are some of the mental status questionnaires?

Answer 14

Beck depression inventory - II (BDI II)

Geriatric depression scale

Question 15

What are yellow flag outcomes?

Answer 15

Psychosocial outcomes

Question 16

What are examples of yellow flag outcomes?

Answer 16

• Fear Avoidance Beliefs Questionnaire (better of the 2)
– Measures beliefs about activity and pain in
normal activity and work
• Modified Work APGAR
– Questions about job tasks and interpersonal
relationships on the job.

Question 17

What are Waddell’s signs (5)?

Answer 17

1. Superficial or Non-anatomic Tenderness
2. Simulation
   – LBP with axial loading or standing rotation of the
   shoulders and pelvis
3. Distraction
   – 40o-45o difference Supine SLR to Sitting SLR
4. Regional disturbances
   – Unexplained weakness or sensory findings
5. Over-reaction
   – Exaggerated responses to testing

Question 18

What does it mean if patient is positive for 3 or more of Waddell’s signs?

Answer 18

Abnormal illness behavior

• Psychological overlay to the pain

Question 19

T/F

Since the patient tested positive for 3 of Waddell’s signs, their condition has now been identified as out of the scope of your practice as a DC. You should refer out.

Answer 19

False

Treat the pain and the psychological overlay.

Question 20

What are functional measures?

Answer 20

• Measure patient’s ability to perform
physical tasks
• Objective measures
– ROM, Reflexes, Strength, Endurance
• Decreased trunk and hip strength /
endurance has been correlated with low
back pain (current and future episodes).

Question 21

What is a yellow flag?

Answer 21

History and examination findings that are risk

factors for developing chronic pain

Question 22

What is a red flag?

Answer 22

– History and examination findings that prompt
the clinician to conduct further diagnostic
procedures

Question 23

If a patient has severe pain (with a cervical injury) after 1 month of care what is suggested?

Answer 23

Yellow flag suggesting possible chronicity, less likely to get better.

Question 24

What is an example of catasrophizing pain coping style?

Answer 24

“I know I’m going to end up in a wheelchair”

Question 25

Low back should get better in how many weeks?

Answer 25

3

Question 26

Neck injury should get better in how many weeks?

Answer 26

4