Do the commonly used standard questionnaires measure what is of concern to patients with low back pain?

Objective: Evaluate whether questionnaires identified all the self-reported patient outcomes raised in focus groups. Design: Mixed methods research combined with qualitative analysis of focus groups. Settings: Physical therapy clinic in a teaching hospital in Brazil. Subjects: A total of 27 patients (aged >18 years, mean age 55.2 years) with chronic non-specific low back pain. Interventions: Three focus groups were conducted by the same investigator and analyzed by meaning unit condensation. The results obtained from the focus groups were codified according to the International Classification of Functioning. A similar process was adopted to codify the Roland-Morris Disability Questionnaire, the Quebec Back Pain Disability Scale and the Oswestry Disability Index according to the International Classification of Functioning. The results of both coding processes were compared. Results: In the analysis, seven main concepts were identified, comprising 77 meaning units. Only three meaning units were not linked to the International Classification of Functioning. Most of the codes present in the questionnaires and focus groups represent limitations to activities. Some codes were identified in the questionnaires that were not mentioned by the focus group participants. No questionnaire assessed environmental factors or problems related to specific parts of the body, and very few assessed body function, all of which were issues raised in the focus groups. Conclusion: This study shows that not all fields considered important by patients to their function are being evaluated, and emotional and contextual factors should be included in clinical assessments in order to fully understand patient need.