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Measuring recovery

Some of us here at The George and at Uni of Sydney started talking a little while ago about what it meant to be recovered from LBP. These discussions grew into an ongoing line of research with a couple of studies so far and a workshop we held at the 2008 LBP Forum in Boston. As a starting point we decided it would be a good idea to do a systematic review, it was just published last year in the European Spine Journal. The thinking behind it was to get a snapshot of how researchers currently measure recovery from LBP, we chose a window of 10 years (1999-2009).

For me there is always mixed feelings about doing systematic reviews; on one hand you want lots of included studies so the results look a bit more robust, but on the other including a large number means heaps of work selecting, appraising, extracting data and trying to combine findings. Anyway, we ended up with a pretty big number of articles (82) which I think makes for a nice study – I can say that I’m happy with that now that the work is finished! The interesting finding was that in those 82 studies there were 66 different measures of recovery. So the situation for the last 10 years has been that pretty much every time someone does a study that includes recovery as an outcome, they invent a new measure. Crazy isn’t it? The LBP situation isn’t unique, David Walton recently conducted a very similar review looking at Whiplash (see below) and found pretty much the same thing, and similar issues have been identified in a wide range of conditions e.g. falls, schizophrenia, peptic ulcers etc

Obviously, this creates some problems for people trying to do meta-analyses using recovery as an outcome but also makes it difficult to interpret the findings of different studies looking at related questions. In my view, whatever you think about recovery, in terms of the way it should be conceptualised or measured, the current situation is ridiculous. It seems also that it is a situation that could be improved, at least to some extent, with better communication between research groups.

Kamper SJ, Stanton TR, Williams CM, Maher CG, Hush JM. How is recovery from low back pain measured? A Systematic review of the literature. European Spine Journal. (2010) 20(1):9-18

Walton DM. A review of the definitions of ‘recovery’ used in prognostic studies on whiplash using an ICF framework. Disability & Rehabilitation (2009) 31:943-57