The Low-Back Outcome Scale of Greenough and Fraser

Overview:

Greenough and Fraser developed the Back Outcome Score (LBOS) scale for measuring functional
outcome in a patient with low back pain. The authors are from Middleborough General Hospital in
England and Royal Adelaide Hospital in Australia.

Parameters:

(1) current pain from a 10 cm (or 100 mm) visual analogue scale (VAS)
(2) employment
(3) domestic chores or "odd jobs"
(4) sport or active social activities (like dancing)
(5) resting
(6) treatment or consultation with health care provider
(7) analgesia
(8) sex life
(9) sleeping
(10) walking
(11) sitting
(12) traveling
(13) dressing

Parameter Finding Points

current pain 7 to 10 cm VAS 0

5 to 6 cm VAS 3

3 to 4 cm VAS 6

0 to 2 9

employment unemployed because of back pain 0

part time 3

full time lighter 6

full time original 9

domestic chores or odd jobs none 0

a few but not many 3

most or all but more slowly 6

normally 9

sport or active social activities none 0

some but much less than before 3

back to previous level 9

resting resting more than half the day 0

no need to rest 6

treatment or consultation more than once per month 0

about once per month 2

rarely 4

never 6

analgesia several times each day 0

almost every day 2

occasionally 4

never 6

sex life severely affected impossible 0

moderately affected difficult 2

mildly affected 4

unaffected 6

sleeping severely affected impossible 0

moderately affected difficult 1

mildly affected 2

unaffected 3

walking severely affected impossible 0

moderately affected difficult 1

mildly affected 2

unaffected 3

Sitting severely affected impossible 0

moderately affected difficult 1

mildly affected 2

unaffected 3

Travelling severely affected impossible 0

moderately affected difficult 1

unaffected 3

Dressing severely affected impossible 0

moderately affected difficult 1

mildly affected 2

unaffected 3

where: • The pain scale is a linear scale from 0 to 10 cm with 0 = no pain and 10 = worst
possible pain imaginable.

• The VAS score appears to have gaps (at 2-3 4 and 6-7 cm).

• For employment status housewives are according to previous abilities.

total score = SUM(points for all 13 parameters)

Interpretation: • minimum score: 0

• maximum score: 75

• The higher the score the better the patient's status.

Score Status

>= 65 excellent

50 – 64 good

30 – 49 fair

0 – 29 poor

References:

Greenough CG Fraser RD. Assessment of outcome in patients with low-back pain. Spine. 1992; 17:
36-41 (Table 1 page 37).

Greenough CG. Results of treatment of lumbar spine disorders. Acta Orthop Scand. 1993;
Supplement 251: 126-129.

Woertgen C Holzschuh M et al. Does the choice of outcome scale influence prognostic factors for
lumbar disc surgery? Eur Spine J. 1997; 6: 173-180.

Woertgen C Gliese M et al. Short term prognostic factors in lumbar disc surgery: The low back
prognostic score is of predictive value. Zentralbl Neurochir. 1998; 30: 4-13.