By Introduction
Back pain is usually subjective and hard to measure. Doctors get info from patients on how they feel and what symptoms they have. This is combined with physical exams and tests like imaging or lab results to get a more complete picture.
Subjective assessment tools include questionnaires, pain scales, and surveys. These show the effect pain has on daily life. Objective assessments involve posture analysis, range of motion tests, muscle strength testing, and neurological assessments.
Imaging scans like X-rays, MRIs, and CT scans help doctors diagnose back pain. Lab tests may also be done to gain more insight.
Subjective Assessment Tools
Subjective assessment tools measure the patient’s self-reported pain levels. They are simpler and cheaper to administer than other tools. But, subjective assessments can be impacted by the patient’s mental state and stress. Therefore, it is vital to look at the accuracy of a patient’s self-reported pain levels.
Visual Analogue Scale (VAS)
The Visual Analogue Scale (VAS) is a tool used to measure back pain. It’s a line, usually 10 cm long. The ends are labeled “no pain” and “worst possible pain”. Patients draw a mark on the line at the intensity of their pain. The distance from the left end is their back pain score.
VAS is an effective tool. It provides objective evidence to clinicians. It’s easy to use, requires no training, and self-administration may improve accuracy. This is why VAS is still used by healthcare professionals today.
Numerical Rating Scale (NRS)
The Numerical Rating Scale (NRS) is a tool for measuring back pain. It has 0 for no pain, and 10 for the worst pain. Patients rate their own pain at that moment. It gives an idea of how bad the pain is.
The NRS has been proven trustworthy and useful for seeing improvements in patients with pain. It can be used to compare pain before and after treatment, or for tracking changes over time. Research suggests that the score on the NRS may predict which treatments would help people with chronic or acute back pain.
Verbal Rating Scale (VRS)
The Verbal Rating Scale (VRS) is a popular tool used for pain assessment. It allows patients to report their pain level on a scale from 0 (no pain) to 10 (worst possible pain). This helps the doctor or physical therapist understand the patient’s pain. It also allows for questions about quality of life and living with chronic pain.
The VRS provides qualitative descriptions from the patient about their condition compared to before treatment. It also gives insight into the emotional component. Essen et al. discuss the consequences of chronic low back pain and daily activities.
Oswestry Disability Index
The Oswestry Disability Index (ODI) is a tool used by healthcare professionals to measure pain and disability caused by lower back pain. It consists of 10 questions, with answers given on a scale of 0-4. A score of 0-100 is calculated, with higher scores indicating more disability. Generally, it is recommended for back pain of less than 6 months duration.
Questions on the ODI relate to daily activities, such as standing and walking, bending, lifting, worrying, taking medications, and writing or brushing hair. Answers range from 0 (no difficulty) to 4 (unable). A final score of 0-100 is calculated. This helps healthcare professionals evaluate treatments and decide if further interventions are needed.
Objective Assessment Tools
Objective assessment tools measure back pain without relying on the patient’s self-report. These tools give an unbiased, reliable, and precise way of measuring pain. Let’s explore some of the most popular objective assessment tools for back pain:
Range of Motion (ROM)
Range of motion (ROM) is an important objective measure used by physical therapists. It helps to evaluate a person’s joints and strength and is used in injury evaluation, diagnosis, and treatment correlation. ROM measures flexibility and tests muscles to assess the whole body. It should be considered with a patient’s age, symptoms, and history when assessing back pain.
Physical therapists measure ROM at the spinal and extremity level. Patients are asked to bend or twist and arm or leg movement is evaluated for stiffness or pain that limits movement. Pain is also monitored from head to toe.
There are 3 ways physical therapists evaluate ROM:
- Goniometry is an objective assessment technique that uses tools to measure joint angles.
- Visual estimation is where soft tissue movement is observed.
- Manual muscle testing (MMT) is where pressure is applied to muscles and their strength is monitored.
Results are compared to normal data for subject-matched population to observe potential abnormalities linked with conditions like back pain.
Joint Mobility Tests
Joint mobility tests are an objective way of diagnosing and tracking musculoskeletal conditions. They involve the patient actively moving their joints to check stiffness, range of motion, and inflammation. Any joint can be tested, but lumbar spine, hips, shoulders, and knees are commonly tested.
Generally, physical therapists or doctors conduct joint mobility testing. Types of tests include:
- Goniometry – measuring joint range of motion with two or more pivots connected by an arm
- Functional ROM/ROM testing – assessing how far each joint can move without help
- Active ROM – testing how much you can move each joint to full range without help
- Passive ROM – measuring how much movement is achieved when someone else moves your joint
- Manual stimuli tests – using finger or hand pressure on particular points along the joint line
These tests can help doctors decide risk factors such as current pain levels, past joint pain and motion loss, flexibility, strength deficits in muscles around the tested area, and functional limitations that may affect daily activities.
Muscle Strength Tests
Muscle strength tests measure the force of contraction that an individual muscle or group of muscles can create against resistance. When assessing back pain, the amount of force generated and the range of motion of a joint or segment can be looked at. Here are some common tests used to assess back pain:
- Manual Muscle Testing (MMT): This is used to see the difference in muscle strength between sides. It also measures active ROM (range of motion) to track changes over time.
- Isometric Contraction Strength Test: The patient pushes against resistance to measure the maximum force production. This can be done using manual resistance, weight machines, hand-held dynamometer, or a strain gauge.
- Isokinetic Exercise Strength Test: Muscles move as fast as possible at different speed increments, while continuously measuring torque output.
- Functional Performance Tests: A series of tasks to see how an individual does with activities like lifting and carrying objects. This tests different joints and muscles used together for movement.
Special Tests
Clinicians assess back pain by ordering special tests. These tests measure joint stability, check neurological functions, and assess range of motion. Examples of special tests include:
- Straight leg raise test – to rule out sciatica and herniated discs in the lumbar spine.
- Braggard’s test – to identify sacroiliac joint dysfunction.
- FABER test – for pain related to sacroiliac joints on one side of the lower back.
- Compression flexion/distraction (CFD) – to measure uneven Range Of Motion or tightness/instability on one side.
- Deep Tendon Reflexes (DTRs) – to measure reflex responses using calibrated hammers.
These tests help clinicians understand what is causing your back pain and diagnose it correctly. Knowing why you feel certain sensations or which structures cause discomfort can lead to finding a treatment plan for long term relief.
Conclusion
To finish, assessing back pain is essential for making informed choices about a person’s care and treatment. We looked into two assessment tools – subjective and objective – which help healthcare workers identify and treat back pain.
Subjective assessments involve the patient rating the intensity and kind of their symptoms. Objective assessments use physical exams, imaging tests, or other approaches to test or dismiss certain conditions as causes of back pain.
It is important to note that no single assessment tool can give a definite answer on the cause of a person’s back pain. Rather, they are used together to assist healthcare workers in forming an accurate diagnosis.
Frequently Asked Questions
1. What is the difference between subjective and objective assessments for measuring back pain?
Subjective assessments rely on the individual’s perception and description of their pain, while objective assessments use physical measurements and tests to assess the severity and location of back pain.
2. What are some common subjective assessment tools for measuring back pain?
Visual analog scales, numeric rating scales, and pain diaries are all commonly used subjective assessment tools for measuring back pain.
3. What are some common objective assessment tools for measuring back pain?
Range of motion tests, muscle strength tests, and imaging studies such as X-rays and MRI scans are all commonly used objective assessment tools for measuring back pain.
4. Can self-reported pain be accurate?
While self-reported pain may not always align perfectly with objective measurements, it can still be a valuable tool in assessing an individual’s pain and helping to guide treatment plans.
5. Are there any potential drawbacks to relying solely on subjective assessments for measuring back pain?
One potential drawback is that subjective assessments may not always accurately reflect the underlying cause or severity of the pain, leading to a misdiagnosis or ineffective treatment plan.
6. Can combining subjective and objective assessments provide a more accurate picture of an individual’s back pain?
Yes, combining subjective and objective assessments can give a more comprehensive understanding of an individual’s back pain, allowing for more targeted and effective treatment plans.
