Effectiveness measures

In this feasibility study, to estimate the impact of SIM on patients' beliefs and early clinical change, the outcome variables were assessed at baseline and 3-month face-to-face follow-up visit.

Pain intensity was measured using 100 points (0 as no pain and 100 representing the worst imaginable pain) NRS.[8]

Functional disability was assessed using Modified Oswestry Low Back Pain Disability Questionnaire (MODQ)[9] which covers 10 domains of functional ability, that is, pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, travelling and employment/homemaking with a score ranging from 0 to 50 (higher scores represent severe disability). The total score (ranging from 0 to 50) is multiplied by two and expressed as a percentage for MODQ index (MODQI)

The FABQ (0–96) is a questionnaire consisting of 16 items with each item scored on a point scale of 0 to 6. High values suggest increased levels of fear-avoidance beliefs.[10] Two validated sub-scales, that is, a work subscale consisting of seven items (FABQ-W; range: 0–42 points) and a physical activity subscale consisting of four items (FABQ-PA; range: 0–24 points) were also used as measurement tools for the study.[11]

EuroQol-5D (EQ-5D) is a standardised measure of health status across five dimensions viz. mobility, pain/discomfort, usual activities, self-care and anxiety/depression with the hierarchy of responses consisting of five levels (no problem, slight problem, moderate problem, severe problem and extreme problem). The health state using EQ-5D was defined using a unique 5-digit numeric code developed by combining the level of response from each of the five dimensions. This code was further valued for a single index score which ranges from −0.109 to 1.0. The calculation of the EQ-5D index score was based on the value set for the United Kingdom, as no value set for India is available.[12] The permission for the same was sought from the EuroQol group. The visual analogue scale (EQ-5D VAS) which is a part of EQ-5D was not used in the study.

Knowledge level was assessed by employing a questionnaire consisting of 10-items with a score range of 0–10. Higher scores represent higher knowledge level. The questionnaire was developed based on the information of SIM and modified after face validity assessment from experts (orthopaedicians, rheumatologists, general physicians, neurologists, pain physicians and medical experts). After which it was tested on 10 patients, so as to ensure that it accurately measures what it aims to do, irrespective of the responder. Thereafter, the developed questionnaire was used for collecting data.