Objectification of functional improvement after nonoperative care

Study Design. In this article, the authors review the three broad categories of measures that have been used to objectify functional improvement after nonoperative care of painful spinal disorder patients - physical, psychological, and socioeconomic. For each of the three categories, the major measures used are discussed, as well as research relating to the efficacy of the measures. Objectives. To point out the many differences that still exist among research studies regarding which functional outcome measures to use and when to use them. Summary of Background Data. During the past few decades, it has been made abundantly clear that painful spinal disorders, particularly when associated with work disability and/or financial benefits, result from a complex interaction of medical, psychological, and social factors. This has resulted in frequent confusion regarding what constitutes the primary roots of the disabling process. Currently, a more comprehensive biopsychosocial perspective of chronic pain and disability has emerged that has significant implications for diagnostic and treatment philosophies of practitioners. Methods. Identifying the measures frequently used to address the important biopsychosocial factors, and evaluating their relative benefits and drawbacks. Results and Conclusions. It is demonstrated that there has been an overall trend in recent years toward using more objective, quantifiable instruments, encompassing the physical, psychological, and socioeconomic parameters of outcomes research in painful spinal disorders. These changes will certainly improve the ability of researchers to tease out which factors tap more directly into such issues as physical impairment, as well as create greater uniformity of measures that will permit direct comparisons between studies.