Oswestry Disability Index (ODI)

Introduction to the Oswestry Disability Index

The Oswestry Disability Index (ODI) was pioneered by John O’Brien in 1976 and was developed following patient interviews which focused on low back pain. In 1980, O’Brien et al. published an initial version of the questionnaire, which has since been modified several times to date.1,2 The ODI is now a widely used questionnaire for assessing functional status and quality-of-life impairment in patients with low back pain or spinal cord disease and injury in research and clinical settings.3 – 6 The most current version of the ODI is version 2.1.a. which is designed to provide information on how back pain affects patients’ ability to manage everyday activities.3

Content

The ODI is comprised of 10 items and assesses functional status and quality-of-life impairment in patients with acute or chronic low back pain. For mild to moderate disability, the Roland-Morris Disability Questionnaire is regarded as being more suitable. 7 The index enquires about functional limitations in various activities of daily living with the index score ranging from 1 (best) to 100 (worst).8 Among others, pain intensity, personal hygiene, walking, sleeping, social life, sexual life (optional) and travel are assessed by the patient. Each section has six possible responses, which are scored from 0 to 5. In theory, only a single response in a single section is required to give an ODI score. The questionnaire has been adapted and validated for many different languages and cultures (including German, French, Chinese, Brazilian Portuguese, Arabic, Turkish, Polish to list a few).4 Completing the questionnaire takes approximately 3-5 minutes.1

10 dimensions (items) in daily life considered by the ODI

  • Pain 9
  • Personal care
  • Lifting
  • Walking
  • Sitting
  • Standing
  • Sleeping
  • Sex Life
  • Social Life
  • Travelling

Evaluation

Each item consists of 6 statements (scores 0-5) and is scored by the patient in reference to his/her current functional status. A sum is formed from the points given, which is then divided by the maximum value (50 points). If only one question remains unanswered, the maximum value drops accordingly to 45 points and the score can be evaluated normally.10 The resulting score is then multiplied by 100 to provide a percentage which is referred to as the total score which ranges from 1 – 100%, with higher scores indicating a more severe disability The author, Fairbanks recommends rounding the final percentage score to whole numbers.2

For example:

If all 10 sections are completed the score is calculated as follows:

If 22 (total scored) out of 50 (total possible score) x 100 = 44%

If one section is missed (or not applicable) the score is calculated:

If 22 (total scored) / 45 (total possible score) x 100 = 48.8% which is rounded up to 49%

Interpretation of the ODI score

0 – 20%: mild disability

20 – 40%: moderate disability

40 – 60%: severe disability

60 – 80%: disabling

80 – 100%: bedridden or functional impairment

Implementation of the EQ-5D-3L

Strengths

The ODI is short (3 – 5 mins), quick to evaluate, and thus comparatively easy to use in the clinic. It has been extensively tested for sensitivity, validity, and reliability in various clinical settings and has demonstrated good psychometric properties.5, 6 It is now a widely used index for the assessment of low back pain.11 It has also been implemented in registries such as the spine registry of the German Spine Society.12

Weaknesses

Many different ODI versions have been used in the literature over the years, some of them modified, unauthorized versions. These are rarely specifically identified, which limits comparability, especially with older studies.13 In addition, question 8 (sexual life) is often omitted by patients.14

License

The ODI is under copyright and a license must be applied for. For students, physicians, non funded academic users and for clinical implementation, use of the ODI is free. Funded academic users, commercial users and IT companies must apply for a license and incur costs.4 Our PRO consultants happily provide more in-detail information.

Conclusion

Overall, the ODI is a robust, widely used score validated in many languages for assessing the functional status of patients with low back pain and their associated disabilities. Question 8 (sex life) could have a limiting effect on patient compliance due to the perceived sensitive nature of the query.

Basically, however, when selecting questionnaires, each researcher/clinician should first decide which outcomes they primarily want to assess.16 – 19 For functionality and quality of life, the ODI is recommended, a multidisciplinary cost-benefit comparison of back interventions should be done using the EQ-5D, etc. In its recommendation for outcome measurement in back pain, the International Consortium for Health Outcomes Measurement (ICHOM) has included the ODI alongside, among others, the EQ-VAS or EQ-5D-3L in its PROMs set.18