Send the patient a two minute questionnaire by link at set points in the plan, store the score on the record, and compare it at the re examination. GoHighLevel can send the link, collect the answers, and remind the patient once. The bottom line: a patient who can see their score fall from 56 to 30 is a patient who believes in the plan, and a clinic that can show it has evidence to support continued care.
The instruments, and what they measure
The Oswestry Disability Index is a validated 10 section questionnaire for low back pain related disability. Each section is scored from 0 to 5, and the total is divided by the maximum and multiplied by 100 to give a percentage, with the common bands being 0 to 20 minimal, 21 to 40 moderate, 41 to 60 severe, 61 to 80 crippling, and 81 to 100 bed bound or symptom magnification, according to MedBridge. The Neck Disability Index is a 10 item questionnaire for neck pain developed in 1989 by Howard Vernon, DC, as a modification of the Oswestry, with each item scored 0 to 5, a raw maximum of 50, and a percentage by doubling the raw score. A numeric pain rating scale asks the patient to rate pain from 0 to 10. Which one to use is a clinical decision for the doctor, based on the region treated.
What counts as a meaningful change
Published estimates of the smallest meaningful change differ. A 2006 study in BMC Musculoskeletal Disorders compared several instruments in back pain patients, including patients from chiropractic practices, and a study protocol cites 10 points on the Oswestry and about 1.5 points on a 10 point pain scale. For the Neck Disability Index, Vernon's guidance says a 5 point raw change, which is 10 percentage points, is clinically meaningful, while another source cites 21 percent. Because the figures vary by population and method, treat them as guides and let the doctor decide what a change means for each patient.
When to ask
| Point in the plan | Questionnaire | Why |
|---|---|---|
| First visit, before the exam | The doctor's chosen instrument | Baseline |
| About visit 4 or 6 | Same instrument, short link | Is the plan working yet? |
| Visit 12, before the re examination | Same instrument | Evidence for the re exam |
| After the plan ends | Same instrument at 30 or 90 days | Does the improvement hold? |
Build it in HighLevel
- Build one survey or form per instrument, with each answer carrying its 0 to 5 value, and add the instructions at the top.
- Create a workflow that starts when Visits completed reaches 4 and again at 11, and send the link with a short text.
- Wait 2 days, check whether the form was submitted with an If/Else on a tag, and send one reminder if it was not.
- Store the total score in a contact field called Latest score and the date in a field called Latest score date, calculated by the survey if your account supports scoring, or entered by staff.
- Create a task for the doctor when a score is submitted, so the change is in front of them before the next visit.
- Add a field Baseline score so the re examination shows both numbers.
- Keep the clinical record in your health records system, and treat HighLevel as the place that sends the link and holds the summary.
A message, written out
Sample: Hi Dana, this is [Clinic]. Your doctor would like a 2 minute check in before your next visit. Please answer the short questionnaire here: [link]. If you have any questions, call us at [number]. Reply STOP to stop messages. The text does not name the questionnaire, the condition, or the region.
Worked example
A clinic with 120 patients in plans sends a questionnaire at about visit 4 to each, which is 120 links. If 60 percent complete it, that is 72 scores (120 times 0.6), and the 48 who do not get one reminder. If the reminder brings in 40 percent of them, that is 19 more (48 times 0.4), for 91 scores in all. The percentages are assumptions to replace with your own.
Privacy
Questionnaire answers are health information. Use the form and storage settings your HIPAA arrangement covers, keep the text itself generic, and limit who in the clinic can see the scores. If you are unsure whether your setup is covered, ask your compliance advisor before you collect any.
What to do with a score that did not improve
A score that stays flat or rises is information for the doctor, not a failure of the system. The task created when a score arrives should include the previous score and the date, so the doctor can decide whether to call the patient, move up a visit, or adjust the plan. Do not message the patient about the score by text. Raise it in the visit or by phone.
Respecting the patient's time
A questionnaire that takes more than 2 or 3 minutes will lose people. Use the shorter versions your doctors accept, ask at set points, not every visit, and tell the patient how the answers will be used. A short explanation, such as it helps your doctor see how you are doing, improves completion more than a reminder does.
How this was handled before
The patient filled out a paper questionnaire in the waiting room at the first visit and again at the re examination, and the doctor compared them by hand. Sending the link between visits gives the clinic a progress line instead of two points.
What to measure
Track links sent, completion within 3 days, average change from baseline, and patients whose score did not improve by the planned visit. The last group is the one the doctor should look at first.
Questions people ask
What is the Oswestry Disability Index?
A validated 10 section questionnaire of low back pain related disability, scored 0 to 5 per section and expressed as a percentage.
What is the Neck Disability Index?
A 10 item questionnaire for neck pain developed in 1989 by Howard Vernon, DC, based on the Oswestry, scored 0 to 5 per item for a raw maximum of 50.
How much change is meaningful?
Published estimates vary, for example about 10 points on the Oswestry and about 5 raw points on the Neck Disability Index, so the doctor should interpret each patient's change.
You can start a GoHighLevel account here and build the questionnaire links, and see forms and surveys in our capabilities demo.