at which level of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) (WHO 2001) a selection of low back pain outcome tools measure.\ud The ICF describes several categories of impact, those on body systems, activity, participation in life roles as well as environmental and personal factors.\ud These categories can be used to relate an outcome measure to the level of the intervention. The results of a study may be compromisedif the outcome measure does not correspond to the level of intervention. For example, a treatment designed to reduce pain should be measured by a tool that measures at a body systems level while an intervention designed to improve return to work needs to measure at the participation level.\ud In order to conduct a trial examining the effects of rehabilitation strategies after lumbar surgery it has been necessary to examine the qualities of commonly used low back pain outcome measures in light of the ICF.\ud Confusion exists as to whether the entities of activity and participation are separate (Dahl 2002). Several attempts have been made to distinguish between the two but as yet, no consensus exists (Granlund2004). It was therefore necessary to define activity and participation and to validate this with a group of qualified health practitioners.\ud \ud J Williamson, C Bulley, F. Coutts, F. MacMilla
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