The Bournemouth Questionnaire (BQ) is a 7-item, multidimensional outcome measure for back or neck pain that takes 3 to 5 minutes to complete. Chiropractors use it at baseline and at every formal re-exam (typically every 4 to 6 visits). A drop of 13 points (about 36% from baseline) on the back version is the commonly cited threshold for clinically meaningful change in chronic patients. Unlike Oswestry or the Neck Disability Index, it explicitly captures fear-avoidance, anxiety, and self-efficacy.
What is the Bournemouth Questionnaire?
The back version was published by Bolton and Breen in 1999 in the Journal of Manipulative and Physiological Therapeutics. The neck version (NBQ) followed in 2002. Each version has 7 items scored 0 to 10. The total ranges from 0 (best) to 70 (worst).
The 7 items cover:
- Pain intensity over the past week
- Interference with daily activities
- Interference with recreational, social, and family activities
- Anxiety symptoms
- Depression symptoms
- Fear-avoidance beliefs about work or activity
- Pain locus of control (self-efficacy)
It was designed specifically for outpatient chiropractic and manual therapy settings, where visit length is short and a full ODI plus separate psychosocial inventory is impractical. Internal consistency (Cronbach's alpha) is typically reported around 0.9.
How do you administer it in practice?
- Baseline: Patient completes the BQ at intake, before or just after the initial exam. Record the total (out of 70) and the 7 sub-scores in the chart.
- Re-exams: Re-administer at every formal re-exam. Common cadences are every 4, 6, or 12 visits, or every 30 days.
- Compute change: Subtract the current total from the baseline total. Express as a percentage of baseline.
- Show the patient. A simple line graph of total scores over time is enough. If they have moved from 42 to 28, they can see it.
- Re-examine the sub-scores. A patient whose pain item drops but whose fear-avoidance item stays high may need a different conversation than a patient improving across all 7 domains.
How does the BQ compare to other chiropractic outcome measures?
| Measure | Items | Domains captured | Time | Best for |
|---|---|---|---|---|
| Bournemouth Questionnaire (BQ) | 7 | Pain, disability, psychosocial, self-efficacy | 3-5 min | Routine chiropractic re-exam, registry reporting |
| Oswestry Disability Index (ODI) | 10 | Low back disability | 5 min | Low back, insurance documentation |
| Neck Disability Index (NDI) | 10 | Neck disability | 5 min | Neck patients, insurance documentation |
| Roland-Morris (RMDQ) | 24 | Low back disability (activity-focused) | 5 min | Acute and subacute LBP |
| PROMIS Physical Function | 4-10 (CAT) | General physical function | 2-3 min | Cross-condition, payer-friendly |
| Patient-Specific Functional Scale (PSFS) | 3-5 | Patient-chosen activities | 2-4 min | Individualized progress signal |
What is a clinically meaningful change?
A reduction of 13 points (about 36% of baseline) on the back BQ is the most commonly cited minimal clinically important difference for chronic patients. For acute and subacute presentations, expect larger drops, and the threshold for what counts as meaningful change rises accordingly. Always interpret the change as a percentage of the patient's own baseline rather than an absolute number, because patients starting at 55 have more headroom than patients starting at 22.
Sub-score changes also matter. A drop in the pain item without a drop in the fear-avoidance item is a flag that the patient may relapse even though the headline number looks better.
Survey data: In a 2026 survey of 455 patients who stopped chiropractic care, 58% cited perception-based reasons: 36% felt no progress, and 22% felt better and stopped. A standardized re-exam score they can see is one of the cheapest interventions against both failure modes.
Where does the Bournemouth Questionnaire fit in chiropractic research?
The 2025 scoping review "Where are the chiropractic clinical outcomes registries?" by Walker and colleagues identified Spine IQ as the only large-scale dedicated chiropractic outcomes registry in operation. Spine IQ collects the Bournemouth Questionnaire as one of its standardized patient-reported outcomes alongside ODI and PROMIS. Clinics participating in the registry use BQ totals to benchmark their outcomes against other practices.
That registry-level adoption is one of the strongest reasons to pick BQ over a longer single-domain scale: the comparison data already exists.
What are common BQ mistakes?
| Mistake | Why it matters | Fix |
|---|---|---|
| Only tracking the total | You miss psychosocial sub-scores that predict relapse | Chart the 7 sub-scores too |
| Comparing absolute change instead of percentage | A 10-point drop from 60 to 50 is not the same as 30 to 20 | Use % change from baseline |
| Re-administering too often | Patient noise outweighs treatment signal | Stick to formal re-exam cadence |
| Confusing back BQ with neck BQ | Different validation samples, different reference data | Use the version matched to the primary complaint |
| Not showing the patient the trend | Wastes the retention signal | Spend 30 seconds at re-exam reviewing the graph |
How does the BQ fit alongside objective tissue measures?
Patient-reported outcomes like the BQ capture how the patient feels and functions. Objective tissue measures, including soft tissue stiffness assessed by myotonometry or elastography, capture what the tissue is doing. The two channels do not always move together. A patient whose BQ has dropped 20 points but whose paraspinal stiffness is still elevated bilaterally may feel better but still be carrying the load pattern that brought them in.
Used together, a patient-reported score and a tissue measurement give you two independent confirmations that the patient is actually progressing, not just having a good week.
Frequently Asked Questions
What is the Bournemouth Questionnaire?
A brief 7-item outcome measure developed by Bolton and Breen in 1999 for low back pain, with a neck version added in 2002. Each item scored 0-10, total 0-70. Captures pain, disability, psychosocial factors, and self-efficacy.
How do chiropractors use the Bournemouth Questionnaire?
Administer at intake, then re-administer at every formal re-exam (every 4-6 visits or every 30 days). Track total and sub-score change. A 13-point or 36% drop from baseline is clinically meaningful for chronic back pain.
What is a clinically meaningful change on the BQ?
About 13 points or 36% from baseline on the back BQ in chronic patients. Acute and subacute cases require larger drops to be meaningful. Always interpret change as a percentage of the patient's own baseline.
How is the BQ different from Oswestry or NDI?
ODI and NDI focus on physical disability. The BQ is multidimensional, capturing pain, disability, anxiety, depression, fear-avoidance, and self-efficacy in 7 items. It is shorter and designed specifically for outpatient manual therapy settings.
Is the Bournemouth Questionnaire used in chiropractic research?
Yes. The 2025 scoping review of chiropractic outcomes registries identified the BQ as one of the standardized outcome measures collected by Spine IQ, the only large dedicated chiropractic outcomes registry in operation.
How long does it take a patient to complete?
Three to five minutes at intake, faster at follow-up. Scoring takes about 15 seconds: sum the 7 item scores for a total out of 70. Most EHRs can store and graph the totals automatically.
Is there a charge to use it?
No. The BQ and NBQ are freely available for clinical and research use. Both are published in the peer-reviewed literature and reproduced on professional sites including chiro.org.
One approach is to add a second channel of objective data alongside subjective pain reports. Options include soft tissue stiffness measurement (such as MuscleMap), range-of-motion testing, and posture analysis. Each gives you something concrete to show the patient rather than asking them to take your word for it.