Retaining the patient perspective in the International Classification of Functioning, Disability and Health Core Set for low back pain

Cecilie Røe^1,2, Unni Sveen¹, Erik Bautz-Holter^1,2

¹Department of Physical Medicine and Rehabilitation, Ulleval University Hospital, Oslo, Norway; ²Faculty of Medicine, University of Oslo, Norway

Objective: To examine the relationship between health problems as rated by the health professionals in the Norwegian form of the Core Set for low back pain and the patients’ self-reported health problems in Oswestry Disability Index (ODI) and World Health Organization Disability Assessment Schedule II (WHODAS II).

Methods: This was part of an international multicenter study where a convenience sample of 118 Norwegian patients with low back pain (LBP) participated. The ICF Core Set for LBP was filled in by the health professionals. The patients reported their health problems in the WHODAS II and ODI. The items in WHODAS II and ODI were linked to the ICF. The problems reported in WHODAS II and ODI were compared to the problems scored by the health professionals in the linked ICF categories in the Comprehensive ICF Core Set for LBP.

Results: All items in ODI could be linked the ICF. Four items in WHODAS II could not be linked to the ICF and additionally two items could not be linked to specific ICF categories. All ICF categories linked to the ODI were included in the Comprehensive Core Set for LBP, whereas six items in WHODAS II could not be linked, and additionally 11 of the items were not represented in the Core Set. With the exception of sexual function, above three quarter of the patients’ reported problems within body functions was captured by the health professionals. Within several of the activities and participation categories the health professionals scores in the ICF reflected the patients’ reported problems well. Surprisingly some of the problems in activities of daily living were poorly reflected.

Conclusion: The Comprehensive ICF Core Set for LBP covers most of the items in ODI and WHODAS II in areas where patients report significant problems, with some exceptions. The subjective dimension related to the impact of the health condition as well as the feeling of being a burden to their family appeared to be important to these patients and not covered in the ICF. Problems with sexual functions and relationship were poorly reflected in the health professionals’ scores in the Comprehensive ICF Core Set for LBP. In clinical practice it is a challenge to assess the individual patients’ broad spectrum of problems precisely.

Keywords: low back pain, WHODAS II, ICF, musculoskeletal disorders