Low Back Pain Rating Scale of Manniche et al.

 

Measures in rating scale:

(1) back and leg pain (60 points)

(2) disability index (30 points)

(3) physical impairment (40 points)

 

Back and Leg Pain

 

Visual analogue scales (VAS) ranging from 0 (no pain) to 10 (worst imaginable pain):

(1) back pain at the time of the examination

(2) leg pain at the time of the examination

(3) the worst back pain within the last 2 weeks

(4) the worst leg pain within the last 2 weeks

(5) average level of back pain during the last 2 weeks

(6) average level of leg pain during the past 2 weeks

 

pain index =

= SUM(points for all 6 visual analogue scales)

 

Disability Index

 

The disability index is based on 15 Questions (Table 1, page 319)

Responses	Points	Forward	Reverse
not a problem	0	yes	no
can be a problem	1	can be	can be
is a problem	2	no	yes

 

Forward questions: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,

Reverse questions: 12, 13, 14, 15

 

NOTE: In the paper, scoring is given as yes = 0; can be problem = 1; no = 2. However, these responses for the last 4 questions reverse the general trend of the first 11 questions. It makes more sense to me to reverse the scoring for the last 4 questions.

 

disability index =

= SUM(points for all 15 questions)

 

Physical Impairment

 

Measures:

(1) endurance of back muscles: length of time that the patient can lie horizontal above the floor with the legs strapped to a bench and the trunk unsupported from the level of the iliac crest

(2) back mobility: modified Schober's test (see Calin, 1998): (a) draw a line between the posterior iliac spines, then (b) identify a point 10 cm above the midpoint of the line, then (c) with the person bending forward measure the distance from that point to the midpoint of the line connecting the posterior iliac spines, and (d) determine the distraction = increase in measurement while bending forward.

(3) overall mobility: fastest time taken to go from (a) lying supine on a flat couch 80 cm above the floor to (b) standing beside the couch, then (c) walking to the end of the couch where (d) a deep knee bend is done and then (e) return to the starting position.

(4) use of analgesics: based on the frequency of use for non-narcotic and narcotic analgesics

 

Measure	Finding	Points
back muscle endurance	>= 270 seconds	0
	240 – 269 seconds	1
	210 – 239 seconds	2
	180 – 209 seconds	3
	150 – 179 seconds	4
	120 – 149 seconds	5
	90 – 119 seconds	6
	60 – 89 seconds	7
	30 – 59 seconds	8
	1 – 29 seconds	9
	0 seconds	10
back mobility (modified Schober's test)	>= 60 mm	0
	50 – 59 mm	2
	40 – 49 mm	4
	30 – 39 mm	6
	20 – 29 mm	8
	0 – 19 mm	10
overall mobility test	< 10 seconds	0
	10 –19 seconds	2
	20 – 29 seconds	4
	30 – 39 seconds	6
	40 – 49 seconds	8
	>= 50 seconds	10
analgesic use	none during past week	0
	use NSAID or non-narcotic analgesic 1-4 times a week	2
	use of NSAID or non-narcotic analgesic 5+ times a week	4
	use of morphine or analogues 1-4 times a week	8
	use of morphine or analogues 5+ times a week	10

 

impairment index =

= SUM(points for all 4 measures)

 

Interpretation:

• minimum score for subscores and total: 0

• maximum pain index: 60

• maximum disability index: 30

• maximum physical impairment: 40

• maximum total points: 130

• The higher the score, the greater the level of disability and impairment.

 

Performance:

• The scale was found to be reliable based on comparisons with the Global Assessments reported by an experienced clinician and the patient.

• Inter-rater agreement is high.