Standardised outcome measures

The STarT Back screening tool helps primary care match patients to treatment appropriate for them.

Tool

• Keele StarT back screening tool  - PDF
• Keele StarT back screening tool  - online version

Scoring

• The tool consists of nine items, each with a value of zero to one.
• The score is calculated by summing the points from each question.
• A minimum score of zero points and a maximum score of nine points.
• Patients who have scores of three or less points have a low risk for future disabling low back pain and associated activity limitations.
• Patients who have scores of four points or greater have an elevated risk for the same adverse outcomes.

To differentiate between medium and high-risk patient populations, a Psychosocial Distress sub score is calculated, which involves summing the point values of the last five items.

In the setting of a score of four points or greater, patients with a Distress sub score of zero to three points are classified as medium risk and patients with a Distress sub score of four points or greater are classified as high risk for future disabling low back pain.

More information

• StarT Back Keele University

The Orebro short form is a ‘yellow flag’ screening tool that predicts long-term disability and failure to return to work. The short form includes 10 items selected from the full version.

Tool

• (OMSPQ-10) - PDF
• (OMSPQ-10) - online version

Scoring

The OMSPQ-10 score is used to predict the potential risk of delayed recovery or longer-term disability and failed return to pre-injury activity and work levels.

The scoring method has been built into the questionnaire and scoring boxes are provided to the right of each item:

• Item 1, on pain duration, the categories 1-10 represent periods of time ranging from “0-1 week” (first box on the left) to “over 1 year” (last box to the right). For example, “6-8 weeks would be scored “5”
• Items 2, 5, 6, 7, 9, and 10 the score is the number circled
• Items 3, 4, and 8 the score is 10 minus the number circled. These items are marked with “10-x” next to the scoring box. For example, if the patient circles 7 for question 3 (“I can sleep at night”), the score will be 10-7= 3
• Write the score for each item in the shaded scoring box
• Score total
  • If using the tool online, the score total in the last shaded box will be calculated as the score for each item is entered.
  • If using a printed version of the tool, add all the scores to obtain the total score and write it in the last shaded box.

The total score will range between 1 and 100, with a score >50 indicating higher estimated risk for future work disability.

The Function in Sitting Test (FIST) assesses sitting balance. It evaluates sensory, motor, proactive, reactive and steady state balance factors.

Tool

• Shirley Ryan Abilitylab – Function in Sitting Test (FIST) – PDF

Scoring

• The test has 14 items, with a zero to four scale that assesses the level of independence or assistance a person needs to complete the task.
• The test can be performed at the patient’s bedside.
• Detailed scoring information is available from Shirley Ryan Abilitylab.

The Headache Disability Index (HDI) was developed to assess functioning and changes in functioning in people with subacute and chronic cervicogenic headache.

Tool

• Allina Health HDI - PDF

The Neck Disability Index (NDI) measures neck-specific disability and is based on the Oswestry Disability Questionnaire.

Tool

• Neck Disability Index (NDI) - PDF

Scoring

• The questionnaire has 10 items concerning pain and activities of daily living including personal care, lifting, reading, headaches, concentration, work status, driving, sleeping and recreation.
• Each item is scored out of 5 (with the ‘no disability’ response given a score of 0) giving a total score for the questionnaire out of 50.
• Higher scores represent greater disability.
• The result can be expressed as a percentage or as raw scores (out of 50).

The guidelines provide more information on scoring.

Patient-Rated Wrist Evaluation (PRWE) assesses wrist pain and disability resulting from wrist conditions.

Tool

• Muscle and Spine Rehab - PDF

Scoring

The Quick Disabilities of the Arm Shoulder and Hand (DASH) measures pain and function in the upper limb and the effect of treatment on pain and shoulder function.

Tool

• USF Health Quick DASH -  PDF
• Ortho Tool Kit - online version

Scoring

The Shoulder Pain and Disability Index (SPADI) measures pain and functioning associated with shoulder pathology and the effect of treatment on pain and shoulder functioning.

Tool

• Ortho Tool Kit - Online version

Scoring

The Upper Extremity Functional Index (UEFI) is used to assesses the functional impairment in individuals with musculoskeletal upper limb dysfunction.

Tool

• Melbourne Pain Group - Upper Extremity Functional Index (UEFI)  - PDF

Scoring

The questionnaire consists of 20 questions on a five point rating scale. Assessing the level of difficulty a person experiences in performing activities of daily living using the upper extremities. Activities that are assessed include household and work activities, hobbies, personal hygiene and driving.

The items are scored zero to 80:

• zero indicating the lowest functional status
• 80 indicating highest functional status.

The minimum amount of change that is considered to be clinically significant is nine points.

The Foot and Ankle Disability Index (FADI) assesses functional limitations related to foot and ankle conditions.

Tool

• Blair PT Foot and Ankle Disability Index (FADI) – PDF
• Orthopaedic Score Foot and Ankle Disability Index (FADI) - online version

Scoring

The questionnaire contains four pain related items and 22 activity related items.

Each item is scored on a five-point scale:

• zero = unable to do so
• four  = no difficulty at all.
• The FADI has a total point value of 104 points, with a 100% result representing no dysfunction.

The Hip Disability and Osteoarthritis Score (HOOS) explores how a hip condition is impacting on the person. The survey can be used to monitor changes in hip function, pain and quality of life with appropriate treatment interventions.

Tool

• Agency for Clinical Innovation HOOS Hip Survey - PDF 
• Ortho Toolkit - online version

Scoring

• The survey consists of 40 items, assessing five outcomes: pain, symptoms, activities of daily living, function in sport and recreation and hip related quality of life.
• Scores are converted to a zero to 100 scale.
• zero represents extreme hip problems and 100 represents no hip problems.
• Scoring is complex, it is recommended that you use an online version.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) assesses short and long-term outcomes following knee injury.

Tool

• Agency for Clinical Innovation KOOS Knee Survey - PDF
• OrthoToolkit - online version

Scoring

The survey consists of 42 items, assessing five outcomes: pain, symptoms, activities of daily living, function in sport and recreation and knee related quality of life.

• Scores are converted to a zero to 100 scale.
• zero represents extreme knee problems and 100 represents no knee problems.
• Scoring is complex, it is recommended that you use an online version.

The Pain Catastrophising Scale (PSC) was developed to quantify an individual’s pain experience, asking about how they feel and what they think about when they are in pain.

Tool

• Mapi Research Trust Pain Catastrophising Scale - online version

Scoring

Use of the tool helps to establish what treatments may be required.

• Less than 20 is mild
• 20 to 30 is high
• Higher than 30 is severe
• Scores evaluate the effect of treatment over time.

The Tampa Scale for Kinseiophobia (TSK) was developed for patients with chronic musculoskeletal pain such as low back pain, neck pain or fibromyalgia. The TSK assesses a person’s fear avoidance, fear of work-related activities, fear of movement and a fear of re-injury.

Tool

• NovoPsych Tampa Scale for Kinseiophobia (TSK) – PDF

Scoring

The questionnaire consists of 17-items.  The total score of the scale range is 17-68, where:

• 68 means severe kinsesiophobia
• 37 indicates there is kinseiophobia.
• 17 means no kinsesiophobia.

More information

• NovoPsych

The Depression Anxiety and Stress Scale (DASS) is a self-report instrument designed to measure the three negative emotional states of depression, anxiety and stress.

Tool

• Depression Anxiety Stress Scales (DASS) – PDF

Scoring

• Each of the three scales includes 14 items, with 42 items in total.
• Patients are asked to rate the extent to which they have experienced a state over the past week using a four point scale.
• Scores are calculated by summing the scores for the relevant items.

More information

• Psychology Foundation of Australia

The Kessler Psychological Distress Scale (K-10) measures psychological distress and monitors outcomes following treatment for common mental health disorders.

Tool

• Black Dog Institute - PDF

Scoring

• The questionnaires has 10 items and uses a five scale response for each question
• Scores range between 10 to 50 and may indicate whether a person is likely to have a mild, moderate or severe mental disorder
• A score of 50 indicates severe distress
• A score of 10 indicates no distress.

The Work Productivity and Activity Impairment Questionnaire (WPAI) is a measure of the impact of health problems on work attendance over the previous seven days.