Reconsidering the Roland-Morris Disability Questionnaire: time for a multidimensional framework?

Area of Science:

• Rehabilitation Medicine
• Psychometrics
• Orthopedics

Background:

• The Roland-Morris Disability Questionnaire (RMDQ) is a widely used tool for assessing back pain disability.
• While typically scored as unidimensional, evidence suggests the RMDQ may possess multidimensional properties.
• This study investigates the underlying factor structure of the RMDQ.

Purpose of the Study:

• To determine the factor structure of the Roland-Morris Disability Questionnaire (RMDQ).
• To assess if a dominant factor exists within the RMDQ.
• To examine if identified RMDQ factors uniquely predict back pain-related outcomes.

Main Methods:

• A cross-sectional study design was employed.
• Exploratory factor analysis was used to analyze RMDQ items from 371 patients with subacute back pain.
• Multiple regression analyses assessed the predictive validity of derived factors on health complaints, distress, coping, and fear avoidance.

Main Results:

• Factor analysis supported a 3-factor solution for the RMDQ after item removal.
• No dominant factor was identified; factors showed moderate correlations, and essential unidimensionality was not supported.
• The 'Symptoms' factor most strongly predicted subjective health complaints; 'avoidance of activity and participation' predicted coping and fear avoidance.

Conclusions:

• The Roland-Morris Disability Questionnaire (RMDQ) comprises 3 independent factors, challenging the notion of a single dominant factor.
• The findings support treating and scoring the RMDQ as a multidimensional scale.
• This approach may offer a more nuanced understanding of back pain disability.