Open Access Research article

A within-subjects trial to test the equivalence of online and paper outcome measures: the Roland Morris Disability Questionnaire

Felicity L Bishop1*, Graham Lewis1, Scott Harris2, Naomi McKay3, Philippa Prentice3, Haymo Thiel3 and George T Lewith1

Author Affiliations

1 Complementary Medicine Research Unit, School of Medicine, University of Southampton, Southampton, UK

2 School of Medicine, University of Southampton, Southampton, UK

3 Anglo-European College of Chiropractic, Bournemouth, UK

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BMC Musculoskeletal Disorders 2010, 11:113  doi:10.1186/1471-2474-11-113

Published: 8 June 2010



Augmenting validated paper versions of existing outcome measures with an equivalent online version may offer substantial research advantages (cost, rapidity and reliability). However, equivalence of online and paper questionnaires cannot be assumed, nor can acceptability to respondents. The aim was to test whether online and written versions of the Roland Morris Disability Questionnaire (RMDQ), a standard measure of functional disability in back pain, are equivalent at both group and individual levels to establish whether they can be used interchangeably.


This is a within-participants equivalence study. 167 participants with back pain fully completed both the paper and online versions of the RMDQ in random order. Participants were recruited from a chiropractic clinic and patient support groups in Southern England. Limits of equivalence were pre-defined as 0.5 RMDQ points, the Bland-Altman range was calculated, and participants' comments were examined using content analysis.


The mean score difference was 0.03 (SD = 1.43), with the 95% Confidence Interval falling entirely within our limits of equivalence (-0.19 to 0.25). The Bland-Altman range was -2.77 to 2.83 RMDQ points. Participants identified unique advantages and disadvantages associated with each version of the RMDQ.


The group and individual level data suggest that online and paper versions of the RMDQ are equivalent and can be used interchangeably. The Bland-Altman range appears to reflect the known measurement properties of the RMDQ. Furthermore, participants' comments confirmed the potential value to be had from offering them the choice of completing the RMDQ online or on paper.