The use of pain, function and quality of life questionnaires in AposTherapy

The use of pain, function and quality of life questionnaires in AposTherapy

In AposTherapy the use of validated and reliable, pain, function and quality of life questionnaires is standard procedure to evaluate the effectiveness of the treatment for each individual patient who attends an AposTherapy Centre and to enable informed clinical decision making. The results of the surveys are made available, upon patient consent, to referring clinicians and insurance companies as outcome measures.

AposTherapy and Pain, Function and Quality of Life Questionnaires

At the AposTherapy Centres, all patients fill out the SF-36 questionnaire regardless of their presenting condition. This questionnaire is a generic questionnaire meaning that it is not disease or population specific. It is composed of 36 questions and requires the selection of a multiple choice answer. The SF-36 is a survey of health and assesses the patient as a whole, taking into consideration wider factors that influence health and not just focusing on their knee or back pain. It considers health in 8 sub-sections and the answers from the questions in each section give a score from 0-100. The sub-sections are; vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health. In 2002 Garratt et al (1) found the SF-36 to be, "the most widely evaluated measure,” in a bibliographic study of quality of life measures published in the British Medical Journal. It has been found to be a valid, reliable and responsive outcome measure and is widely recognised in the medical community.
In addition to the SF-36 patients will then fill out a disease specific questionnaire which is validated for their presenting condition. By using a specific measure there is focus on problems and areas of function which are specifically related to the disease. In a review of the literature about the SF-36, Ware (2) found that the most useful types of research studies were those that used the SF-36 as a core measurement and then supplemented it with a disease specific measure. By using the two types of measurements, the generic health survey and a disease specific measure as standard clinical practise AposTherapists are provided with a full overview of each individual patient’s perspective throughout their treatment.
The disease specific questionnaire used at AposTherapy for knee and hip osteoarthritis is the Western Onatrio and McMaster Universities Osteoarthritis Index (WOMAC) which is validated for both of these conditions (3). The WOMAC assesses the patient in 3 areas: pain, stiffness and physical function and produces a total score as well as a score for each category. A 100mm visual analogue scale is used and patients rate themselves for each section, lower WOMAC score indicates less pain, less stiffness and better physical functioning.
The Oswestry Disability Index is used for patients presenting with low back pain. In an article published in Spine (2000), Bombardier (4) summarises the available outcome assessments for spinal disorders and recommends both the Oswestry and the SF-36 for use.
In addition the Foot and Ankle Survery (FAOS) is used for patient’s presenting with foot and ankle problems and the Harris Hip Score for patient’s post total hip arthoplasty.
At AposTherapy Centres the questionnaires are filled in prior to initial consultation and then subsequently prior to each follow-up consultation throughout the full treatment programme. This enables the AposTherapist to track the patient’s condition via a quantifiable, valid and reliable measure at each point along the therapy process with comparison to a baseline measure before the patient commenced AposTherapy.
An important aspect of pain and quality of life questionnaires at AposTherapy is that they are completed on a computerised system, without the presence of the AposTherapist. This significantly decreases possible bias.
The AposTherapist has access to the patient’s questionnaires via the Patient Questionnaire Tracking System which displays the results in a graphical and numerical format enabling easy comparison between the patient’s status now and at previous points throughout their treatment journey. This tool demonstrates to both the AposTherapist and the patient the improvement in well being and reduction in reported pain and disability levels and can also highlight any deterioration.
The questionnaires can also act as a tool to guide AposTherapists questioning during the subjective interview at follow up consultations and encourage a holistic approach to the delivery of care. In addition it allows the AposTherapist to compare a patient to the average levels of pain, function and well being of a group of patients suffering from the same pathology. This allows AposTherapy to evaluate the effectiveness of the treatment for specific pathologies over large patient numbers. In addition it can act as a tool for an individual therapist to track their patient’s progress and allow them to evaluate their own delivery of AposTherapy and its effectiveness.


  1. Garratt A, Schmedit L, Mackintosh A, Fitzpatrick. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 2002;324:1417-9
  2. Ware, J. SF-36® Health Survey Update
  3. Bellamy N. WOMAC Osteoarthritis Index User Guide. Version V. Brisbane, Australia 2002.
  4. Bombardier, C. Outcome Assessments in the Evaluation of Treatment of Spinal Disorders: Summary and General Recommendations. Spine 2000;24:3100-3103

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