Five questions predicted long-term, severe, back-related functional limitations: Evidence from three large prospective studies

Clermont E. Dionne, Natalie Le Sage, Renée Louise Franche, Michel Dorval, Claire Bombardier, Richard A. Deyo

Research output: Contribution to journalArticle

13 Scopus citations


Objectives: The objectives of the study were as follows: (1) to investigate whether the predictive validity of a previously developed back pain prediction rule could be improved; (2) to determine if the rule can be shortened without loss of predictive validity; (3) to compare the rule with the physician's judgment; (4) to assess, in a different population, its 2-year predictive validity; and (5) to evaluate the clinical applicability of the rule in a first-line care setting. Study Design and Setting: One thousand two hundred and sixty-two participants were enrolled in the study (participation: 91%) before a medical consultation for nonspecific back pain in a large emergency room and were followed up for 2 years (follow-up: 92.5%). The effects of adding new items and deleting any one of the original items were evaluated. The predictions by the rule and the physicians were compared with the 2-year actual functional limitations (measured with the Roland-Morris Disability Questionnaire). Results: Although the final prediction rule included only five items (feeling everything is an effort, trouble getting breath, hot/cold spells, numbness/tingling in parts of body, and pain in heart/chest), its predictive validity was greater than that of the original 17-item version and was superior to the physician's prediction. The rule was easily applied. Conclusion: A five-item clinical prediction rule of long-term back-related functional limitations could help first-line care physicians to concentrate the clinical attention on patients at higher risk.

Original languageEnglish (US)
Pages (from-to)54-66
Number of pages13
JournalJournal of Clinical Epidemiology
Issue number1
StatePublished - Jan 1 2011



  • Back pain
  • Clinical judgment
  • Clinical rules
  • Functional limitations
  • Prediction
  • Prognosis

ASJC Scopus subject areas

  • Epidemiology

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