Assessment of back-related quality of life: the continuing challenge

It is always gratifying to be acknowledged by a colleague and asked to give a talk in a faraway land about a topic of one's particular interest. To be invited, however, to give the Harry Farfan Presidential Lecture at the 27th Meeting of the International Society for the Study of the Lumbar Spine is, for me, a special honor and privilege. Too many years ago, when I was a very junior faculty member at the School of Physical and Occupational Therapy at McGill University in Montreal, Canada, we offered our students a course in Orthopedic Conditions. This course was primarily taught by orthopedic surgeons, rheumatologists, and other members of the medical profession with special interest in disorders of the musculoskeletal system. Teaching in this course was considered to be a professional obligation at McGill, and, while most individuals accepted the invitation, they did so with varying degrees of enthusiasm. Each year, Dr. Harry Farfan graciously agreed and provided several lectures for our students. He told them about the surgical management of problems of the lumbar spine and the necessity of treating the "whole" patient, as well as about his theory as to the cause of low back pain. At that point in time, we were not talking about quality of life as an outcome of care for our patients, but I cannot help but believe that he would keenly approve of the subject of this presentation.