Developing a functional outcome measure for individuals with low back pain within a Jordanian physiotherapy service

Low back pain (LBP) is a chronic condition that leads to disability and work absence. It affects patients’ lives regardless of their age, gender, social status, level of education or culture. After the common cold, LBP is the second condition that results in health seeking behaviour and has a consequential social burden, as well as a global burden, on the health economy. Limitations in physical functioning arising from LBP affect other dimensions of quality of life, such as mental and social functioning. Therefore, LBP is considered a multidimensional problem. Targeted physiotherapy interventions are used to improve functional outcomes in individuals with LBP. However, a number of problems exist on the measurement of the effectiveness and efficiency of these complex interventions in a clinical context. A valid, reliable and responsive outcome measure that is underpinned by theoretical and clinical knowledge is required to address these issues. The aim of this thesis is to develop a clinical measure suitable for research and for implementation in the Jordanian healthcare system for the measurement of functional outcomes in people with LBP. The research process involved three phases, namely, conceptualisation of the problems, development of the measurement tool and clinical testing of the measurement tool. Different research methods were used in this research programme to achieve the objectives. In the conceptualisation phase, a systematic review of the global prevalence of LBP was conducted to compare the prevalence of LBP in different countries with that in Jordan. This process was followed by a meta-synthesis of qualitative studies that investigated the impact of LBP on people’s lives, as well as of critical reviews of management models of LBP, theory of measuring scales and scaling methods. These reviews resulted in the development of a theoretical framework to measure functional status in individuals with LBP and the identification of measurement standards in a clinical context. This framework was used at the end of the conceptualisation phase to critically review six of the most commonly used LBP outcome measures. After the conceptualisation phase, a new outcome measure of functional performance in individuals with LBP was determined to be necessary. A mixed-methods approach was used in the development of the measurement tool phase. The Treatment Evaluation by LE Roux (TELER) method of measurement was utilised in the development and validation of a new outcome measure of functional performance, in which rigorous and extensive qualitative methods, such as in-depth interviews and nominal group techniques, were used. In the clinical testing phase, the TELER LBP indicators were tested in Jordanian physiotherapy clinics. This testing provided evidence of the clinical utility of the TELER LBP indicators in generating informative data appropriate to inform clinical decision-making. This thesis has contributed to the development of measurement in the musculoskeletal field by providing a new clinical tool that is underpinned by sound theoretical, clinical and empirical knowledge. The tool is appropriate for use in clinical evaluation and has potential use in research. This thesis provides a solid base upon which further new knowledge can be developed in the future