Oswestry Disability Index
Original Editor - Rachael Lowe
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Objective
The Oswestry Disability Index (ODI) a patient-completed questionnaire which gives a subjective percentage score of level of function (disability) in activities of daily living in those rehabilitating from low back pain. It was developed by Jeremy Fairbank and Graham Pynsent in Oswestry, England in 1980[1] and considered one of the best accepted tools for assessment of low back pain[2].
Oswestry Low Back Pain Disability Questionnaire
Intended Population
Acute or chronic low back pain. Most effective for persistent severe disability, while the Roland-Morris is better for mild to moderate disability[3]. The test is considered the ‘gold standard’ of low back functional outcome tools. [1]
Method of Use
The questionnaire examines the level of disability in 10 everyday activities of daily living.
- Pain intensity
- Personal care
- Lifting
- Walking
- Sitting
- Standing
- Sleeping
- Sex (if applicable)
- Social
- Travel
Each item consist of 6 statements which are scored from 0 to 5. With 0 indicating the least disability and 5 the greatest then the total score is calculated as a percentage, with 0% indicating no disability and 100% indicating the highest level of disability.
Interpretation of scores
| 0% to 20%: minimal disability: | The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting sitting and exercise. |
|---|---|
| 21%-40%: moderate disability: | The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means. |
| 41%-60%: severe disability: | Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation. |
| 61%-80%: crippled: | Back pain impinges on all aspects of the patient's life. Positive intervention is required. |
| 81%-100%: | These patients are either bed-bound or exaggerating their symptoms. |
Scale
Owestry Disability Index Scale
Video explaining the scale [4]
From Paper Based to Electronic Patient Record Systems
Conventionally Oswestry Disability Index (ODI) is applied as paper based forms. With the development of internet technologies, online calculator tools for ODI become popular. Electronic patient record (EPR) systems are specialised databases for management of patient's health records. By the integration of EPR and outcome measure databases, distance patient assessment can be possible.
In 2007, Irmak and Ergun has an experimental tool for integration of EPR and online assessment systems for Oswestry Disability Index (ODI) and roll and Morris Questionnaire by using different programming languages and databases; PHP-Mysql, C# Javascript, and MS Access. Currently, this system is available for online calculation and assessment for non registered users. For scientists, a distance patient assessment interface is also available.
The Oswestry Disability Index (ODI) was originally developed in English but has now been translated into over 40 languages.
Evidence
Research has concluded that the ODI is a valid, reliable and responsive clinical tool when used to determine the level of function (disability) associated with low back pain.[5]
Reliability
The Oswestry Disability Index (ODI) addresses a broader concept of disability than that directly related to pain intensity[6]. Test-retest reliability was consistently high across studies[7] (mean ICC value of 0.937 ± 0.032), with the lowest ICC reported by Grotle et al. (0.880)[8] and the highest by Mannion et al. (0.96)[9].
Validity
In a study 1997 by Fisher K, Johnston M it was concluded that the measure had good face validity, where patients found it relevant with none of them refusing to complete it. However, they found there were moderately clear relationships between reported ability on walking and sitting and the actual measured performance on these activities, although lifting was not as well validated[10].
In a more recent study by Vianin in 2008 the ODI construct validity was tested and it found that compared to other outcome measures that measure disability due to low back pain, the ODI was found to be consistent with them. This shows that the ODI is a valid measure of disability due to low back pain[5].
Responsiveness
In a study by Walsh et al did not find that there was a significant benefit of using condition-specific outcome measures. However, they did report that the ODI has been found to have a greater responsiveness when comparing the measurement of function over pain[11]. The Nepali version of ODI is a responsive scale capable of distinguishing between stable and improving disability levels in participants with LBP and it can serve as an evaluative tool for assessing disability over time and monitoring treatment effects[12].
Miscellaneous
Oswestry Disability Index (ODI) may not be sensitive to detect subtle changes in disability, particularly in patients with very mild or very severe disability. This as, patients may score near the minimum or maximum possible score, making it challenging to differentiate improvements accurately. Also, it does not cover all aspects of disability or quality of life affected by low back pain. For example, it may not fully contain emotional, social, or psychological aspects of the condition, which can also be critical in understanding the overall impact on a person's life[1].
Resources
References
- ↑ 1.0 1.1 1.2 Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000 Nov 15;25(22):2940-53.
- ↑ Garg A, Pathak H, Churyukanov MV, Uppin RB, Slobodin TM. Low back pain: critical assessment of various scales. European Spine Journal. 2020 Mar;29:503-18.
- ↑ Davies, Claire C.1; Nitz, Arthur J. Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: a systematic review. Physical Therapy Reviews, Volume 14, Number 6, December 2009 , pp. 399-408(10)
- ↑ BMH learning. Oswestry Disability Index | Oswestry Low Back Pain Disability Questionnaire | [Internet]. YouTube. 2023 [cited 2024 Sep 13]. Available from: https://www.youtube.com/watch?v=2ytPNlBFODE
- ↑ 5.0 5.1 Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. Journal of chiropractic medicine. 2008 Dec 1;7(4):161-3.
- ↑ Grönblad M, Hupli M, Wennerstrand P, Järvinen E, Lukinmaa A, Kouri JP, Karaharju EO. Intel-correlation and test-retest reliability of the pain disability index (PDI) and the Oswestry disability questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. The Clinical journal of pain. 1993 Sep 1;9(3):189-95.
- ↑ Sheahan PJ, Nelson-Wong EJ, Fischer SL. A review of culturally adapted versions of the Oswestry Disability Index: the adaptation process, construct validity, test–retest reliability and internal consistency. Disability and rehabilitation. 2015 Dec 4;37(25):2367-74.
- ↑ Grotle M, Brox JI, Vollestad NK. Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. Journal of rehabilitation medicine. 2003 Oct 1;35(5):241-7.
- ↑ Mannion AF, Junge A, Fairbank JC, Dvorak J, Grob D. Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity. European spine journal. 2006 Feb;15:55-65.
- ↑ Fisher K, Johnston M. Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience. Physiotherapy theory and practice. 1997 Jan 1;13(1):67-80.
- ↑ Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary?: the responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine. 2003 Mar 15;28(6):607-15.
- ↑ Binaya K, Kajal T, Ranjeeta AS, Govinda N. Responsiveness of Nepali version of Oswestry Disability Index (ODI) on individuals with non-specific low back pain. Journal of Patient-Reported Outcomes. 2021 Dec;5:1-7.