Evaluation of the multi-level Roland-Morris disability questionnaire Wunpen Chansirinukor, Christopher G. Maher, and Jane Latimer The Roland-Morris Disability Questionnaire (RM24) contains 24 items, patients completing the questionnaire by ticking the items that apply to them. It is likely that requiring a patient to respond in this manner may lose information about the patient’s disability. Developing a similar questionnaire with a multi-level response option would address this. Therefore, the aims of this study were to develop a modified version of the RM24 (multi-level RM24) and to evaluate its measurement properties. In a series of three studies involving 667 patients with low back pain the descriptive statistical properties of the multi-level RM24 and the psychometric properties of the original and multi-level RM24 were evaluated. The multi-level RM24 was shown to have good internal consistency, reliability and cross-sectional construct validity, and to minimize the ceiling effect found in the RM24. The longitudinal construct validity for the multi-level RM24 was also greater than for the RM24. In conclusion, replacing the yes=no response option with a multi-level response option improves the measurement properties of the RM24. INTRODUCTION People with low back problems often experience pain, physical impairment and dis- ability (Waddell, 1987). Disability relates to the person’s restricted ability to perform activities of daily living and hence one of the main goals of physical therapy management of low back pain (LBP) is to reduce disability. Clinicians need valid, reliable and responsive measure- ment tools to evaluate disability and to assess outcome from treatment. Typically disability is assessed using self-report measures that provide the patients’ perspectives on the impact of their back pain on function (Beurskens, de vet, and Ko ¨ke, 1996; Davidson and Keating, 2002a). The 24 item Roland-Morris Disability Questionnaire (RM24) (Roland and Morris, 1983) is one of the most frequently used out- come measures for LBP (Roland and Fairbank, 2000). The RM24 was originally derived from the Sickness Impact Profile (SIP), which is a 136-item generic health status measure for use in chronic diseases (Bergner et al, 1981). The Wunpen Chansirinukor, PT, PhD student, School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, East Street, Lidcombe, 2141, Sydney, Australia. E-mail: wcha1745@mail.u- syd.edu.au Christopher G Maher, PT, Associate Professor, School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, East Street, Lidcombe, 2141, Sydney, Australia. Jane Latimer, PT, Senior Lecturer, School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, East Street, Lidcombe, 2141, Sydney, Australia. This study was approved by the Human Research Ethics Committee of The University of Sydney and by the Research Ethics Committee of Liverpool Hospital. Accepted for publication 26 September 2003. Physiotherapy Theory and Practice, 20: 1À15, 2004 Copyright # Taylor & Francis Inc. ISSN: 0959-3985 print=1521-0510 online DOI: 10.1080/09593980490425049