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Patient Reported Outcome Measures (PROMs) are reports completed by patients about how they feel or function in relation to a health condition/therapeutic intervention. They can assess whether an intervention is improving a patient’s symptoms, health, or functionality with limited risk of professional bias or interpretation. PROMs also provide uniform assessment of patients over time and allow for quantitative assessment and evaluation of changes in patient status.
The use of PROMs in practice is encouraged as they can provide strong evidenced based practice which will help advocate and validate the Australian osteopathic profession, provide a strong basis for any improvement in patient care/status from osteopathic intervention, and help build the professional standard of osteopathic care alongside other allied health professions in Australia. The use of standardised outcome measures also benefits patients as they may improve safety, efficacy, and delivery of care which often result in better patient outcomes.
Found below is a list of commonly used and validated outcome measures that may be useful to you as an osteopath. The list provides detail about each measure as well as a downloadable PDF. The list is not exhaustive and new measures may be added over time.
Note: Cronbach’s alpha is a measure of reliability, specifically the internal consistency of a scale. Generally, alpha values over .70 are good with higher values reflecting better internal consistency.
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: 10-item questionnaire that assesses neck pain and its effect on daily living. The score produced indicates the individual’s level of self-rated disability and can be used to monitor change over time.
VALIDITY, RELIABILITY, SENSITIVITY: Excellent (Cronbach’s α 0.87-0.92) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): The questionnaire consists of 10 questions, and each question produces a score from 0 (no disability) to 5 (complete disability). For scoring the number for each question is added together to produce a total score between 0 to 50, with 50 being the highest level of disability.
INSTRUCTIONS FOR USE (for patients): This questionnaire will ask about how your neck pain is affecting your ability to manage in everyday life. For each question, please select the statement which best applies to you.
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Download Neck Disability Index (NDI) or Complete Neck Disability Index (NDI) online
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Pain/Disability
DESCRIPTION: Short questionnaire that is used to assess pain and difficulty using upper extremities/disability of the shoulder. The questionnaire is divided into two subscales being: pain (5 items) and disability (8 items). It also comes in a visual and numeric version, though the visual scale is not commonly used.
VALIDITY, RELIABILITY, SENSITIVITY: Excellent (Cronbach’s α 0.90-0.95) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): The pain scale is summed up to a total of 50 while the disability scale sums up to 80 – both can then be expressed as a percentage. The total SPADI score is also calculated as a percentage. Scoring details are included in the PDF download. Scores of 0 indicate best 100 indicates worst. A higher score is indicative of higher levels of pain and/or disability.
INSTRUCTIONS FOR USE (for patients): Please circle the number that best represents your experience during the last week attributable to your shoulder problem.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Functionality
DESCRIPTION: Used to assess functional ability for up to five activities that that a patient deems important e.g., getting dressed, or more specifically, putting socks on. Patients rate the current level of difficulty for each task and are asked to rate them again following treatment/intervention.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.81 - 0.91) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): Measure is given at initial assessment and then at follow up assessments over time. There is no total score calculated and the measure is not used to compare clients (though possible to do so in research settings6), but rather individual items are followed over time to assess change. The minimal detectable change for an average score is 2, and 3 points for an individual activity score.
INSTRUCTIONS FOR USE (for patients): Please list up to 5 important everyday tasks/activities that you are unable to perform or have difficulty with as a result of your condition. Next to each task, please rate how difficult you find it (between 0 to 10 – 0 being unable to perform the task and 10 being able to perform the activity at the same level as you could prior to injury/condition.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Functionality
DESCRIPTION: Assesses impairments on productivity and regular activities in paid and unpaid work (over the last seven days). It explores items such as absenteeism, presenteeism, and work performance.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.74) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): The WPAI produces four scores: Absenteeism, presenteeism, work productivity loss and activity Impairment. WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity. Scores are multiplied by 100 so to express them as percentages.
Percent work time missed due to problem: Q2a/(Q2a+Q2b+Q3)
Percent impairment while working due to problem: Q4a/10
Percent overall work impairment due to problem:
Q2a/(Q2a+Q2b+Q3) + {(1-(Q2a+Q2b)/(Q2a+Q2b+Q3)) x Q4a/10
Percent activity impairment due to problem: Q5a/10
Percent work time missed due to all health: (Q2a+Q2b)/(Q2a+Q2b+Q3)
Percent impairment while working due to all health: (Q4a+Q4b)/10
Percent overall work impairment due to all health:
(Q2a+Q2b)/(Q2a+Q2b+Q3) + {(1-(Q2a+Q2b)/(Q2a+Q2b+Q3)) x (Q4a+Q4b)/10
Percent activity impairment due to all health: (Q5a+Q5b)/10
INSTRUCTIONS FOR USE (for patients): The following questions ask about the effect of your health problems (physical and/or emotional) on your ability to work and perform regular activities. Please fill in the blanks or circle a number, as indicated by each question.
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Download Work Productivity and Activity Impairment Questionnaire (WPAI-GH)
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Pain
DESCRIPTION: Assesses an individual’s confidence to perform a task while suffering from persistent pain and in turn, assesses the impact that pain Is having on their daily life. The measure covers a range of activities such as household chores, work, leisure, and general lifestyle.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.76 - 0.95) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): By tallying the number selected for each of the 10 items/activities, the measure provides a total score between 0-60. Higher scores are indicative of higher levels of confidence. Scores <20 = severe, 20 to 30 = moderate, 31 to 40 = mild, >40 = minimal impairment
INSTRUCTIONS FOR USE (for patients): Please rate how confident you are that you can do the following things at present, despite the pain. To indicate your answer, circle one of the options between 0 and 6 - 0 being “not at all confident" and 6 being "completely confident". Remember, this questionnaire is not asking whether or not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Pain
DESCRIPTION: Used to assess catastrophising (catastrophic thinking) related to pain. The item can be used for individuals with and without chronic pain.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.90 - 0.94) 1, 2, 3, 4 5
INSTRUCTIONS AND NOTES (for clinicians): Scoring consists of a total score and three subscales being: Rumination (items 8, 9, 10, 11), Magnification (items 6, 7, 13), Helplessness (items 1, 2, 3, 4, 5, 12). Score ranges: Total: 0-52, Rumination 0-16, Magnification 0-12, Helplessness 0-24 with higher scores indicating higher levels of catastrophising. Total score <20 = mild, 20-30 = high, >30 indicates severe/clinically relevant catastrophising.
INSTRUCTIONS FOR USE (for patients): We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the following scale, please read each statement and indicate the degree to which you have these thoughts and feelings when you are experiencing pain. The Scale is between 0 to 4 – 0 being not at all, and 4 being all the time.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Pain
DESCRIPTION: Assesses neuropathic pain in adults with lower back pain via a 9-item questionnaire.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.76 – 0.78 ) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): The measure consists of 9 items. Seven sensory items graded from 0 (= never) to 5 (= strongly), one temporal item course pattern graded from −1 to +1, and one spatial item graded 0 (for no radiation) or +2 (for radiating pain). From the nine items, a total score between −1 to 38 can be calculated. Higher scores indicating higher levels of neuropathic pain. Suggested cut offs: Scores ≥19 indicate neuropathic pain is likely, while scores ≤12 indicate neuropathic pain is unlikely.
INSTRUCTIONS FOR USE (for patients):
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Pain
DESCRIPTION: Used to measure the impact that pain has on an individual’s ability to participate in everyday activities. The measure can be used for an initial evaluation and then over time and to judge the effectiveness of an intervention.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.86) 1, 2, 3
INSTRUCTIONS AND NOTES (for clinicians): The measure is a seven-item scale and individual items are measured on a scale of 0 – 10. A total score is then calculated out of 70 where higher scores are indicative of a higher impact of pain on daily activities.
INSTRUCTIONS FOR USE (for patients): The rating scales below are designed to measure the degree to which aspects of your life are disrupted by chronic pain. In other words, we would like to know how much pain is preventing you from doing what you would normally do or from doing it as well as you normally would. Respond to each category indicating the overall impact of pain in your life, not just when pain is at its worst. For each of the 7 categories of life activity listed, please circle the number on the scale that describes the level of disability you typically experience. A score of 0 means no disability at all, and a score of 10 signifies that all the activities in which you would normally be involved have been totally disrupted or prevented by your pain.
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Self-Report Population: Adult Difficulty: Easy (10min) Cost: Free Use: Quality of Life
DESCRIPTION: Assesses an individual’s quality of life. The measure covers eight key concepts of health: physical functioning, body pain, role limitations due to physical/emotional/personal health problems, emotional well-being, social functioning, energy/fatigue, general health perceptions and perceived change in health.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.70 – 0.95) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): The scoring process requires 2 main steps as outlined in the link below. Unlike other measures, higher SF-36 scores reflect better quality of life. Each item is also scored on a 0 to 100 range. Scoring details: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html
INSTRUCTIONS FOR USE (for patients):
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Kinesiophobia
DESCRIPTION: the TSK is a 17 item self-report questionnaire evaluating fear of movement and re-injury. While originally used for patients with chronic low back pain, it is now widely used for most parts of the body. The tool uses a 4-point scale for assessment based on fear-avoidance, fear of work-related activities, fear of movement, and fear of re-injury.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.70 - 0.83) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): The TSK has two subscales: Activity Avoidance (the beliefs that activity may cause injury or increased pain per items 1, 2, 7, 9 – 12) and Somatic Focus (the belief in underlying serious medical problems per items 3, 4, 5, 6 and 8).
Scoring is based on a 4-point Likert scale where: Items 1, 2, 3, 5, 6, 7,9, 10, 11, 13, 14, 15 and 17 are scored as between 1 being strongly disagree and 4 being strongly agree. However, items 4, 8, 12 and 16 are inverted so that 4 is strongly disagree and 1 is strongly agree. A total score between 17- 68 can then be calculated where higher scores (over 37) indicate a higher degree of kinesiophobia.
INSTRUCTIONS FOR USE (for patients): Please read the following list and provide a score between 1 and 4 for each item - 1 for strongly disagree and 4 for strongly agree. Please note that for some items, the scores are inverted so that 4 means strongly disagree and 1 means strongly agree.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Whiplash
DESCRIPTION: A tool using a clinical prediction rule for whiplash. The tool will assist you in judging the likelihood of recovery for patients with whiplash injury. It groups patients at various levels of risk such as risk of developing moderate / severe disability or experiencing full recovery following injury.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α NA) 1, 2
INSTRUCTIONS AND NOTES (for clinicians): More information on scoring and prediction can be found at recover.centre.uq.edu.au/whiplash-associated-disorders-clinician-resources or in the PDF download. Follow the diagram to make predictions about the likelihood of recovery.
INSTRUCTIONS FOR USE (for patients): Part 1 - this questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the one box that applies to you. Part 2 if applicable (aged 35 and over) - below is a list of difficulties people sometimes have after stressful life events. Please read each item, and then indicate how distressing each difficulty has been for you during the past seven days with respect to the motor vehicle accident. How much were you distressed or bothered by these difficulties?
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The OMPQ is a screening tool that predicts long-term disability and failure to return to work when completed four to 12 weeks following a soft tissue injury.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.82 – 0.96) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): The OMPQ uses a total score. A cut-off score of 105 has been found to predict those who will recover, those who will have no further sick leave in the next six months, and those who will have long-term sick leave. Detailed scoring information can be found on the PDF download.
INSTRUCTIONS FOR USE (for patients): Please read each question carefully and answer it as best you can. There are no right or wrong answers. If you have difficulty, select the answer that best describes your situation.
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Download Orebro Musculoskeletal Pain Questionnaire (OMPQ) or Orebro Musculoskeletal Pain Questionnaire (OMPQ) Short Form
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The FADI is a region-specific (foot and ankle) self-report measure of functional limitations. It consists of 26-items, specifically 4 pain related items and 22 activity related items.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α NA) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): Each of the 26 FADI items are scored on a 5-point Likert scale from 0 (unable to do) to 4 (no difficulty at all). A total score is then used to calculate the percentage of impairment. This is done as follows:
Number of Completed Responses (‘n’): _________ (max = 26)
FADI Score = (sum of n responses/n x 4) ×100
INSTRUCTIONS FOR USE (for patients): Please answer every question with one response that most closely describes your condition within the past week. If the activity in question is limited by something other than your foot or ankle, then please mark Not Applicable (N/A).
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Download Foot and Ankle Disability Index (FADI) or Complete Foot and Ankle Disability Index (FADI) online
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The RMQ is a 24-item self-report questionnaire used to assess self-rated physical disability associated with lower back pain.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate (Cronbach’s α 0.83-0.94) 1, 2, 3, 4, 5, 6
INSTRUCTIONS AND NOTES (for clinicians): The RMQ is scored by adding up the number of items checked by the patient with a total score of 24 possible. Cut off scores are not provided. However, clinical improvement over time can be graded. For example, at the beginning of treatment, a patient’s may have scored 12 and, at the conclusion of treatment, their score was 2 (10 points of improvement)- this would calculate an 83% (10/12 x 100) improvement.
INSTRUCTIONS FOR USE (for patients): When your back hurts, you may find it difficult to do some of the things you normally do. This list contains some sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because they describe your situation today. As you read the list, think of yourself today. When you read a sentence that describes your situation today, put a tick next to it. If the sentence does not describe your situation, then go on to the next one.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The ODI assesses lower back pain in relation to its impact on daily living and functional ability. It consists of 10 sections (questions) which are scored on a scale of 0 to 5 with 5 representing the highest level of disability.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.85 – 0.94) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): If a patient marks more than one statement in a question, the highest scoring statement is recorded as a true answer. Scores can be calculated using the following formula: (total score/5 x the number of questions answers) x 100. This will give you a percentage value. Interpretation: 0% to 20%: minimal disability: The patient can cope with most living activities. Usually, no treatment is indicated apart from advice on lifting sitting and exercise. 21%-40%: moderate disability: The patient experiences more pain and difficulty with sitting, lifting, and standing. Travel and social life are more difficult, and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected, and the patient can usually be managed by conservative means. 41%-60%: severe disability: Pain remains the main problem in this group, but activities of daily living are affected. These patients require a detailed investigation. 61%-80%: crippled: Back pain impinges on all aspects of the patient's life. Positive intervention is required. 81%-100%: These patients are either bed-bound or exaggerating their symptoms.
INSTRUCTIONS FOR USE (for patients): This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by putting a mark in each section for the statement which best applies to you. We realize you may consider that two or more statements in any one section apply but please just check the box that indicates that statement that most clearly describes your problem.
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If completed online, it can be scored automatically
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The UEFI is used to assess functional impairment in individuals with musculoskeletal upper limb dysfunction (including the shoulder, elbow, wrist, and hand). More specifically, it assesses the level of difficulty an individual has performing activities of daily living such as household duties, work activities, hobbies, etc. The 15-item UEFI is recommended over the 20-item UEFI because of its unidimensional nature.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.90 - 0.94) 1, 2, 3, 4
INSTRUCTIONS AND NOTES (for clinicians): For soring, a total score is first calculated between 0 and 59. Please not that higher scores are indicative of lower limitations rather than higher limitations.The raw score is then converted to a percentage using the table provided in the PDF download. A minimum detectable change of 9 is recommended.
INSTRUCTIONS FOR USE (for patients): We are interested in knowing whether you are having any difficulty with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer between 0 and 4 for each activity. 4 represents no difficulty and 0 represents extreme difficulty or inability to perform the task.
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Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: The LEFS is a measure of lower extremity function and may be used to assess patients at initial consult as well as progress over time.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.90 – 0.96) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): There are 20 questions and answers are valued between 0 and 4. A total score is calculated between 0 and 80 with higher scores being indicative of lower limitations rather than higher limitations. The raw score can then be converted into a percentage of maximal function via: (LEFS score) / 80 x 100. A minimum detectable change of 9 is recommended.
INSTRUCTIONS FOR USE (for patients): We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity. Today, do you or would you have any difficulty at all with:
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Self-Report Population: Adult Difficulty: Easy (10min) Cost: Free Use: Disability
DESCRIPTION: The KOOS is used to evaluate both short- and long-term outcomes in individuals with knee injury and/or osteoarthritis. The measure assesses five separate subscales: pain, symptoms (other), activities of daily living, function in sport and recreation, and knee-related quality of life.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.70 - 0.96) 1, 2, 3, 4, 5, 6
INSTRUCTIONS AND NOTES (for clinicians): The five subscales are scored separately. Each question uses a 5-point Likert scale from 0 (No problems) to 4 (Extreme problems). The sum of each subscale is first calculated to achieve a raw score. The raw score is then transformed to a 0–100 scale, with zero representing extreme knee problems and 100 representing no knee problems. The following formula can be used:
100 − ((raw score x 100) / total possible score for specific subscale)
The total possible score for each subscale is as follows: pain = 36, symptoms = 28, daily living = 68, sport = 20, quality of life = 16
INSTRUCTIONS FOR USE (for patients): This survey asks you about your knee. This information will help us understand how you feel about your knee and how well you are able to perform your usual activities. Answer each question by ticking the appropriate box. Please select only one box for each question. Please answer each question in relation to how you have been feeling over the past week.
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Download Knee Injury and Osteoarthritis Outcome Score (KOOS)
Self-Report Population: Adult Difficulty: Easy (10min) Cost: Free Use: Disability
DESCRIPTION: The HOOS is used to evaluate both short- and long-term outcomes in individuals with hip injury with or without osteoarthritis. The measure assesses five separate subscales: pain, symptoms (including stiffness), activities of daily living, function in sport and recreation, and hip-related quality of life.
VALIDITY, RELIABILITY, SENSITIVITY: Moderate to Excellent (Cronbach’s α 0.82 - 0.98) 1, 2, 3, 4, 5, 6
INSTRUCTIONS AND NOTES (for clinicians): The five subscales are scored separately. Each question uses a 5-point Likert scale from 0 (No problems) to 4 (Extreme problems). The sum of each subscale is first calculated to achieve a raw score. The raw score is then transformed to a 0–100 scale, with zero representing extreme hip disability and 100 representing no hip problems. The following formula can be used:
100 − ((raw score x 100) / total possible score for specific subscale)
The total possible score for each subscale is as follows: symptoms = 20, pain = 40, daily living = 68, sport = 16, quality of life = 16
INSTRUCTIONS FOR USE (for patients): This survey asks you about your hip. This information will help us understand how you feel about your hip and how well you are able to perform your usual activities. Answer each question by ticking the appropriate box. Please select only one box for each question. Please answer each question in relation to how you have been feeling over the past week.
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Download Hip Disability and Osteoarthritis Outcome Scale (HOOS)
Self-Report Population: Adult Difficulty: Easy (5min) Cost: Free Use: Disability
DESCRIPTION: 30-item questionnaire that assesses disability of the upper extremities (arm, shoulder, and hand). Patients can rate difficulty of tasks and interference with daily activities associated with pain/injury and the measure can be used to monitor changes over time. An 11-item short form known as the QuickDASH is also available.
VALIDITY, RELIABILITY, SENSITIVITY: Excellent (Cronbach’s α 0.91 - 0.98) 1, 2, 3, 4, 5
INSTRUCTIONS AND NOTES (for clinicians): The questionnaire rates difficulty on a 5-point Likert scale. Scores are calculated as follows: ([(sum of n responses)/n] -1) x (25). Higher scores are indicative of greater levels of disability. Detailed scoring details can be found on their website https://dash.iwh.on.ca/about-dash
INSTRUCTIONS FOR USE (for patients): This questionnaire asks about your symptoms as well as your ability to perform certain activities. Please answer every question, based on your condition in the last week.
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This report summarises key consultation themes to follow from the new Aged Care Act summary report. We are deeply disappointed that our feedback to the recent open consultation has been overlooked by the Department of Health and Aged Care.
The Community Affairs Legislation Committee has passed the NDIS amendment Bill. Some concerns revolve around the inclusion of osteopathy and ensuring fairness for everyone.
Osteopathy Australia Submission to the Australian Commission on the Safety and Quality Healthcare's guide for the Primary & Community Health Care Standards