Low back pain (LBP) is a common problem affecting populations in industrialized countries, and considered the most common cause of disability in people under 45 years. Pain, disability and quality of life are examples of the common subjective aspects associated with chronic low back and not easy to quantify due to their complex physical, behavioural and psychological effects. The development of tools to measure the outcomes of patients with low back pain has become a subject of increasing interest either for research purposes or for clinicians to justify the effectiveness of their interventions. Ronald and Morris (1983) developed their original questionnaire (Roland Morris Disability Questionnaire RMDQ) to measure the self-rated immobilization resulting from the back pain. It was designed for use in research (e.g. as an outcome measure for clinical trials) but has also been found useful for monitoring patients in clinical practice in primary care in the United Kingdom. It is formulated by choosing statements from the sickness impact profile (SIP) which is a 136-item health status measure covering a wide range of aspects of daily living activities related to physical and mental function. The items of the questionnaire are mainly related to physical activities in order to assess the disability caused by CLBP. It entails simple yes and no answers and can be self administered by the patient in 5 minutes. It is originally designed for administration on paper, However it has shown to be successfully administered on computer and telephone which maximize its clinical utility. A score between 0 (no disability) and 24 (maximum disability) can be easily obtained by adding up the number of checked items, this approach was selected to help clinicians to establish the baseline of the patients' disability and monitor short term changes in patients with low back pain. It could also monitor short term changes in response to treatment. The original version has been modified by Patrick et al (1995) by adding words to the statements to make them more suitable for patients with low back and sciatic pain. Stratford and Binkley (1997) have removed five items that thought to be redundant in order to improve the questionnaire responsiveness. However, the original version of Roland & Morris disability Questionnaire with 24 items are the most widely used version and has been translated to many languages.
Yellow flag therapists are therapists whom (usually unintentionally) contribute to negative management of their patient’s situation by evoking negative thoughts, emotions, false beliefs and maladaptive behaviour. The power of words.. Pain is a brain product that can be shaped differently according to previous and running pain experiences, mood, negative thoughts, believes and words. Yes you have the power over what your patients believe so use it to empower your patients and not to be the most unhelpful risk factors for chronic pain. Things you should never say to your patient: - You have a slipped disc. - Your spine is misaligned and need adjustment. - You have a knee/ hip of 80 years old patient. - You shouldn’t move/ stop going to the gym. - You go for a surgery straight away. - You must change your career/ life style. If our intention is to help our patients, we must update our knowledge on the biopsychosocial model and use our current understanding and skills to help our patients.