It can be scored from 0 to 3 for each response with a total possible score on the ranging check details from 0 to 84. Using this method, a total score of 23/24 is the threshold for the presence of distress. Alternatively the GHQ-28 can be scored with a binary method where Not at all, and No more than usual score 0, and Rather more than usual and Much more than usual score 1. Using this method any score above 4 indicates the presence of distress or ‘caseness’. Reliability and validity: Numerous studies have investigated reliability and validity of the GHQ-28 in various clinical populations. Test-retest reliability has been reported to be high (0.78 to 0 0.9) ( Robinson and Price 1982) and interrater and intrarater

reliability have both been shown to be excellent (Cronbach’s α 0.9–0.95) ( Failde and Ramos 2000). High internal consistency has also been reported ( Failde and Ramos 2000). The GHQ-28 correlates well with the Hospital Depression and Anxiety Scale (HADS) ( Sakakibara et al. 2009) and other measures of depression ( Robinson and Price 1982). The GHQ-28 was developed to be a screening tool and for this reason responsiveness in terms of Minimal Detectable Change (MDC) and Minimally Clinically Important

Difference (MCID) have not been established. Physiotherapists are becoming more aware of the need to screen for psychological and psychiatric co-morbidity in patients under their care. This may be to adapt or modify the physiotherapy approach to management or to institute referral to appropriate Selleck PD0325901 mental health care providers. The GHQ-28 is one of the most widely used and validated questionnaires to screen for emotional distress and possible psychiatric morbidity. It has been tested in numerous populations including people with stroke (Robinson and Price

1982), spinal cord injury (Sakakibara et al 2009), heart disease (Failde and Ramos 2000), and various musculoskeletal conditions including whiplash associated disorders (Sterling et al 2003) and occupational low back pain (Feyer et al 2000) amongst others. Thus for much clinicians there is a wealth of data with which to relate patient outcomes. It assesses the client’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term distress or psychiatric disorders but not to long-standing attributes of the client. There are some disadvantages to use of the GHQ-28 in physiotherapy practice. First, the questionnaire is not freely available and must be purchased. Second, there is the potential for confusion over the different scoring methods, and this has implications for interpretation of scores derived from the questionnaire. There may also be some concern over the severe depression subscale which includes some confronting questions for the patient to answer. Other tools such as the HADS may be less confronting for physiotherapy use.