Low back pain has reached epidemic proportions, being reported by about 80% of the population people at some time in their lives. Seventy-five percent of people with low back pain are between 30 and 59 years of age, i.e. in their most productive years. While not a disease, low back pain is a major cause of disability. The symptoms of low back pain and the associated disability bear only a poor relationship to objective data. Therefore, much effort has been made to try to identify meaningful outcome measures. Condition-specific instruments have been used in clinical studies to address functioning, disability and health of persons with low back pain. However, there is little standardization of the use of these instruments, and comparisons among studies are difficult or impossible. Thus, it would be valuable for teaching, clinical practice and research to define what should be measured to comprehensively represent the experience of patients based on an extensive framework that can serve as a universal language understood by health professionals, researchers, policymakers, patients and patient organizations alike.

To tackle this issue, the ICF Research Branch and the World Health Organisation (WHO) with the scientific support of Ludwig-Maximilian University (Germany), University of Melbourne and Royal Melbourne Hospital (Australia), University of Freiburg (Germany), University Hospital and Maastricht University (The Netherlands), Bone and Joint Decade and the European League against Rheumatism (EULAR), initiated a project to develop internationally-accepted and evidence-based ICF Core Sets for low back pain. This project was part of a larger project examining 12 chronic conditions with a high burden of disease.

The preparatory phase included a systematic literature review, a Delphi exercise and an empirical data collection using the ICF checklist:

• The systematic literature review was performed to identify and compare the concepts contained in outcome measures of randomized, controlled clinical trials published from 1991-2000 involving patients with low back pain.
• The international expert survey (via email) using the Delphi technique was conducted with 37 health professionals, experts on the treatment of persons with low back pain, to identify the set of domains that best describe the prototypical spectrum of problems in functioning and health in persons with low back pain from the of health professional perspective.
• The multicentre cross-sectional study using the ICF checklist with a convenient sample of 163 patients undergoing inpatient or outpatient rehabilitation was performed to identify the common problems experienced by persons with low back pain.

An international ICF consensus conference took place from 26-29 April 2002 at a quiet monastery situated in a pleasant landscape far from any city and distractions. The aim of the conference was to establish the Comprehensive and Brief ICF Core Sets for patients with low back pain. Eighteen experts (physicians in various sub-specialities, physiotherapist, occupational therapists) from 15 different countries decided which ICF categories are to be included in the ICF Core Sets for low back pain following a formal, decision-making and consensus process which integrated the results from the 3 preparatory studies.

78 ICF categories were selected for inclusion in the Comprehensive ICF Core for low back pain. These categories can be taken into account when conducting a comprehensive, multidisciplinary assessment. Out of the 78 Comprehensive ICF Core Set categories, 35 ICF categories were selected as categories for the Brief ICF Core for low back pain. The Brief ICF Core Set can be used in assessing patients participating in a clinical study on low back pain.

Validation studies have been conducted.

For more information, feel free to contact the ICF Research Branch (melissa.selb@paranet.ch).

• Comprehensive & Brief ICF Core Sets for low back pain (download PDF)