Physical function has been identified as a core outcome to be assessed in low back pain (LBP). However, all recommended physical function measures are Patient-Reported Outcome Measures (PROMs). Performance-Based Measures (PBMs) are important measures that are practical and are prone to fewer biases. Two systematic reviews provided evidence on the psychometric properties of PBMs but were not comprehensive. Therefore, the purpose of this study was to identify PBMs developed for or used to assess physical function in LBP and to review studies evaluating the psychometric properties of these PBMs systematically.
The first manuscript of the thesis was the systematic review protocol developed using the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) manual 2018. The protocol was also registered on PROSPERO (CRD42020147968). The protocol also outlined the use of the COMINS Risk of Bias (COSMIN-ROB) checklist 2018; standard priory hypotheses and criterions developed to evaluate the results of each psychometric property; as well as a GRADE criterion (Grading of Recommendations, Assessment, Development and Evaluations) to assess the level of evidence. Two reviewers independently screened, evaluated, and extracted data.
The second manuscript was the systematic review written in the format of a journal for future submission. Our database search identified 47 studies assessing 115 PBMs. In general, findings included five different LBP diagnoses (e.g., non-specific LBP) and different LBP durations (e.g., acute, chronic). The level of evidence of each PBM or psychometric property mainly were generated from single studies. A high risk of bias assessed by the COSMIN-ROB checklist was found for most of the included studies. Overall, the included studies' results often did not meet our priory hypotheses for good psychometric properties. Hence, most PBMs' psychometric properties were found to have a low level of evidence. There was not a single PBM that demonstrated a good level of evidence for all properties. In conclusion, significant heterogeneity was found between studies leading to a limited level of evidence. PBMs need to be used with great caution. High-quality studies that investigate PBMs' psychometric properties are needed. / Thesis / Master of Science Rehabilitation Science (MSc) / Low Back Pain (LBP) care costs the Canadian health care system millions of dollars every year. Most clinicians and researchers use self-report questionnaires filled out by their patients to assess physical function. However, performance measures where patients perform tasks while being observed are also recommended to assess physical function. Performance-based measures can be used alone or in combination with self-report measures. To select the most appropriate performance measures, we need to know how good and trustworthy these measures are. Therefore, the purpose of this study was to collect all possible performance measures that were developed or used to assess physical function in LBP patients; then summarized the available evidence on their psychometric properties (reliability, validity and responsiveness).
We searched five scientific databases and found 47 studies that evaluated 115 performance measures. Most included studies were of low quality and evaluated different tests or test properties. We found that most measures were not reliable, accurate or were sensitive to change. Therefore, clinicians and researchers need caution when selecting and interpreting results of these performance measures when evaluating physical function in LBP.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26439 |
| Date | January 2021 |
| Creators | Alnattah, Maysa |
| Contributors | Macedo, Luciana |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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