INTRODUCTION: In low back pain (LBP), the use of health-related quality of life (HRQOL) measures is limited to generic measures; there is no availability of LBP-HRQOL measures. The generic measures may ask questions that are irrelevant for individuals with LBP, which may reduce the accuracy of patients’ reports. OBJECTIVES: To: 1) identify items best reflecting the domains of HRQOL important to individuals with LBP, and 2) provide evidence for the discriminative capacity of the response options by mapping them onto general health perception. METHODS: This study is a secondary analysis of an existing dataset that consisted of 64 items relating to patients’ symptoms, functional status, and general health perception. Nine important HRQOL domains were identified in previous work using individual interviews with patients, and by National Institute of Health (NIH). The 64 items were classified into different HRQOL domains by 12 participants using the Delphi method. Item response theory (IRT) was then used to estimate the properties of items for each identified domain in order to select items best reflecting each domain of HRQOL important to individuals with LBP. The best item for each domain was selected according to the distribution of the threshold values across the latent scale and the discrimination value. RESULTS: The LBP-HRQOL assessment tool consisted of nine items with three response levels per item. The regression coefficient was consistently decreased between response options and the linear trend test was significant for all selected items. This indicates that the response option for each item had a discriminative capacity for patients’ general health perception. The LBP-HRQOL assessment tool showed a good convergent validity at both item level and total score. CONCLUSIONS: This study identified the items best reflecting the domains of HRQOL in LBP, forming a LBP-HRQOL assessment tool. The selected items need to be reviewed for clarity by patients and clinicians.