How is recovery (from low back pain) measured? A systematic review

[Simon]

Interesting as it seems relevant to the debate about what counts as recovery in ME/CFS

How is recovery from low back pain measured? A systematic review of the literature (Kamper 2010)

Abstract highlights
Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. [only 7 measures used more than once, never in quite the same way]

[using symptoms/function reports to indirectly measure recovery]
Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs.

[asking patients directly about recovery]
There were nine single-item recovery rating scales. Eleven studies used a global change scale that included an anchor of ‘completely recovered’.

[objective measures of recovery]
Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance.

In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently.
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When recovery doesn't mean recovery (from intro)

There is also a fundamental consideration regarding the meaning of recovery; that being whether recovery requires return to a prior health state or whether attainment of a fulfilling and satisfying life within the limitations of the condition is enough [21, 80].

I'm going to focus on the normal meaning of restoration of health here...

 

[Simon]

Pain & disability/function measures or recovery - all assume close to full health
This is akin to the PACE Trial approach of using fatigue and self-rated physical function to define recovery. However, unlike PACE (which set fatigue and function recovery thresholds so low that 1 in 9 patients met a recovery threshold before the trial started) these back pain studies set 'high' recovery thresholds

Examples
Pain scales
- SF-36: Level of Pain 0 (0-6 scale)
- Numerical Rating scale 0 or 1 (0-10 scale)
- Visual Analog Scale 10mm (0-100mm)

Other pain measures:
Have you had back pain in past year (or week in once case)? NO
No backache, cure etc

Disability
RMDQ disability scale <=2 (0-24 scale)
SF36 pain interfering with work or life 0 (0-6) = no interference at all
"Able to perform daily activities as well as before this episode

Some studies required improvements in both pain and disability, but again the recovery threshold was 'high' ie little or no pain or disability.

Patient reports of recovery - again usually only 'complete recovery' used
This invovles a 'recovery' scale, typically 1-6. Some studies also used 'global improvement' scales, usually used to measure amount of improvement but some of these have as the max score of "Completely recovered".

examples
- 'global improvement' scales all used max 'completely recovered' as measure of recovery
- Most recovery scales were 1-5 or 1-6 and used only the maximum score as recovery. But not all:
- Recovery scale 6-point (≤2 is recovered)
- Question: Yes to: “completely better”

By contrast, the PACE trial used a Clinical Global Improvement' scale from 'very much worse' to 'very much better'. It did not include 'recovered' as an option. However, PACE used either 'much better' or 'very much better' as part of its recovery definition.

Worth noting too the comment in the discussion of this review about using patient reports of recovery

This is in contrast to the approach outlined above, where the researchers determine what domains they regard as important in the subject’s recovery

Objective measures including 'Return to equal or own work'
Various objective measures were used, including physical performance measures, self-reported return to work (inc eg return to previous work status) and closure of insurance claims.