The grades of recommendations (standards, guidelines, and options) and classes of evidence (I–III) are defined at the end of the "Major Recommendations" field.
Standards. It is recommended that functional outcome be measured in patients treated for low-back pain due to degenerative disease of the lumbar spine by using reliable, valid, and responsive scales. Examples of these scales in the low-back pain population include the following: The Spinal Stenosis Survey of Stucki, Waddell–Main Questionnaire, Roland-Morris Disability Questionnaire (RMDQ), Dallas Pain Questionnaire (DPQ), Quebec Pain Disability Scale (QPDS), Sickness Impact Profile (SIP), Million Scale, Low Back Pain Rating (LBPR) Scale, Oswestry Disability Index (ODI), the Short Form–12, the Japanese Orthopaedic Association (JOA) system, the Curtain Back Screening Questionnaire (CBSQ), and the North American Spine Society Lumbar Spine Outcome Assessment Instrument.
Guidelines. There is insufficient evidence to recommend a guideline for assessment of functional outcome following fusion for lumbar degenerative disease.
Options. Patient satisfaction scales are recommended for use as outcome measures in retrospective case series, where better alternatives are not available. Patient satisfaction scales are not reliable for the assessment of outcome following intervention for low-back pain.
Summary
Functional disability secondary to acute low-back pain, chronic low-back pain, lumbar stenosis, and lumbar disc disease may be reliably and validly assessed using functional outcome surveys that are valid, reliable, and responsive. Outcome instruments supported by Class I and Class II medical evidence for the evaluation of low-back pain include the Spinal Stenosis Survey of Stucki, Waddell-Main, Roland-Morris Disability Questionnaire, Dallas Pain Questionnaire, Quebec Pain Disability Scale, Sickness Impact Profile, Million Scale, Low Back Pain Rating Scale, Oswestry Disability Index, and the Curtain Back Screening Questionnaire. Many of these outcome measures have been applied to patients who have been treated with lumbar fusion for degenerative lumbar disease and have proven to be valid and responsive; however, the reliability of these instruments has never been specifically assessed in the lumbar fusion patient population. Patient satisfaction surveys have been used to measure outcome following lumbar fusion. Their usefulness resides in their insight into patient attitudes toward the treatment experience but is limited because of their inability to measure responsiveness and the lack of information on their reliability.
Definitions:
Grades of Recommendation
Standards Recommendations of the strongest type, based on Class I evidence reflecting a high degree of clinical certainty
Guidelines Recommendations based on Class II evidence reflecting a moderate degree of clinical certainty
Options Recommendations based on Class III evidence reflecting unclear clinical certainty
Classes of Evidence
Class I Evidence from one or more well-designed, randomized controlled clinical trials, including overviews of such trials
Class II Evidence from one or more well-designed comparative clinical studies, such as nonrandomized cohort studies, case-control studies, and other comparable studies, including less well-designed randomized controlled trials
Class III Evidence from case series, comparative studies with historical controls, case reports, and expert opinion as well as significantly flawed randomized controlled trials