Performance Problems of Patients With Chronic Low-Back Pain and the Measurement of Patient-Centered Outcome

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Abstract
Study Design. In a prospective interventional study, problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months, before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield, United Kingdom. Objectives. To describe problems identified as most important by patients with chronic low-back pain and to evaluate the Canadian Occupational Performance Measure (COPM) as a tool for measuring problem-specific outcomes. Summary of Background Data. Patients with chronic low-back pain report difficulties with a variety of activities. The COPM permits the identification and measurement of problems of particular concern to the patient. Materials and Methods. COPM, likert-modified Roland and Morris Disability Questionnaire, Pain Self-Efficacy Questionnaire, and 5-minute walk test were administered at baseline, immediately after, and 9 months after intervention. Differences and statistical interactions were determined by nonparametric tests. Results. Participants identified 60 different types of problem activity, 45 of which were identified by nine or fewer participants. Decreased walking tolerance was the most frequently identified problem (56% of participants). Improvements were observed in all outcomes following intervention. Approximately one third of participants reported improvements two or more COPM units in overall performance and satisfaction with their performance at 9 months. Higher reported performance and satisfaction were associated with greater self-efficacy. Increased reported walking performance was associated with increased observed 5-minute walk distance (R = 0.35, P = 0.02). Conclusions. Patients with chronic low-back pain report problems with diverse activities. The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual’s goals.