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The Oswestry Disability Index

Article in Occupational Medicine · April 2017

DOI: 10.1093/occmed/kqw051

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QUESTIONNAIRE REVIEW
The Oswestry Disability Index
Originally published in 1980, The Oswestry Disability
Index (ODI) [1] is a validated, 10-point patient-reported
outcome questionnaire. It is considered the ‘gold stand-
ard’ [2] for measuring disability and quality of life (QoL)
impairment for adults with low back pain (LBP). Back
pain is of particular interest to occupational medicine
practitioners, as it has a significant impact on the work-
place, with almost 3 million working days being lost each
year in the UK [3].
The 10 factors which constitute the ODI criteria for
assessing patients’ functional impairment are pain inten-
sity, ease of personal care, lifting, working, sitting, stand-
ing, sleeping, sex life, social life and travelling.
Usage
The ODI can be used to assess both chronic and acute
conditions of varying severity. It has high test-retest reli-
ability [4] and takes around 5 min for a patient to com-
plete. Not only is it straightforward to administer and
score, but it can also be used in a variety of clinical set-
tings [5,6] to assess baseline function and post-interven-
tion outcomes. In the field of occupational medicine, it is
frequently cited in research, as it has an application as a
way of measuring the success of workplace interventions
[7,8]. It also forms part of a screening questionnaire
which predicts long-term work absence [9].
Although the ODI is copyrighted, it can often be used
without charge. Exceptions to this include its usage for
commercial use and funded academic research. In these
cases, royalty and distribution fees apply [10].
Interpretation
Each of the 10 questions is scored from 0 to 5, giving a
maximum score of 50. The total score is then converted
into a percentage by multiplying it by 2. Scores are
stratified into severity: 0–20, minimal disability; 21–40,
moderate disability; 41–60, severe disability; 61–80,
crippling back pain; 81–100, these patients are either
bed-bound or have an exaggeration of their symptoms.
In order for the results to be deemed clinically signifi-
cant, a change in the patient’s score of 10% or more is
required.
Variations
The ODI is available in electronic and paper versions.
It can be accessed in English and >40 other languages,
© The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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Occupational Medicine 2017;67:241–242
doi:10.1093/occmed/kqw051
including Turkish and Brazilian Portuguese, where it has
been culturally adapted and validated [11,12]. The most
current version of ODI is 2.1a.
Other questionnaires
The Keele STarT Back Screening Tool (SBST) [13] may
be more appropriate in cases of chronic and disabling
LBP. The benefit of the SBST is that it includes a treat-
ment option dependent on the patient’s score.
There are some schools of thought who consider
measurements of health status and patient function
are sufficient [14] in LBP. These individuals often
advocate alternative scoring schemata, such as the
Short-Form (36) Health Survey. Such surveys may
play an important role in building up a broader pic-
ture of the impact of LBP on a patient. However, in
isolation, they fail to capture some key psychosocial
factors.
Opinion
It is our opinion that the ODI represents an easily
reproducible, reliable, objective score of disability in
LBP that aids in the long-term management of this
potentially complex patient group. The simplicity of
the ODI makes it particularly suited for occupational
health practitioners, who may be dealing with high
volumes of musculoskeletal cases. This is due not
only to the rapidity in which it can be completed but
also its focused assessment of the impact of the con-
dition or therapeutic interventions on the patient’s
QoL.
Matthew Yates
e-mail: matt.yates@doctors.org.uk
Neil Shastri-Hurst
References
1. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry
Low Back Pain Disability Questionnaire. Physiotherapy
1980;66:271–273.
2. Fairbank JC, Pynsent PB. The Oswestry Disability Index.
Spine (Phila Pa 1976) 2000;25:2940–2952; discussion 2952.
3. Health and Safety Executive. Work-Related Musculoskeletal
Disorder (WRMSDs): Statistics, Great Britain, 2015. October
2015. http://www.hse.gov.uk/statistics/causdis/musculo-
skeletal/msd.pdf (16 February 2016, date last accessed).
 242 QUESTIONNAIRE REVIEW

4. Irmak R, Baltaci G, Ergun N. Long term test-retest reli-
ability of Oswestry Disability Index in male office workers.
Work 2016;53:639–642.
5. Hill JC, Dunn KM, Lewis M et al. A primary care back
pain screening tool: identifying patient subgroups for initial
treatment. Arthritis Rheum 2008;59:632–641.
6. Copay AG, Glassman SD, Subach BR, Berven S, Schuler
TC, Carreon LY. Minimum clinically important difference
in lumbar spine surgery patients: a choice of methods using
the Oswestry Disability Index, Medical Outcomes Study
Questionnaire Short Form 36, and pain scales. Spine J
2008;8:968–974.
7. Karjalainen K, Malmivaara A, Mutanen P, Roine R, Hurri
H, Pohjolainen T. Mini-intervention for subacute low back
pain: two-year follow-up and modifiers of effectiveness.
Spine (Phila Pa 1976) 2004;29:1069–1076.
8. Atlas SJ, Tosteson TD, Blood EA, Skinner JS, Pransky GS,
Weinstein JN. The impact of workers’ compensation on
outcomes of surgical and nonoperative therapy for patients
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1976) 2010;35:89–97.
9. Du Bois M, Donceel P. A screening questionnaire to pre-
dict no return to work within 3 months for low back pain
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10. Oswestry Disability Index [Internet]. February 2016. https://
eprovide.mapi-trust.org/instruments/oswestry-disability-
index (5 April 2016, date last accessed).
11. Yakut E, Düger T, Oksüz C et al. Validation of the Turkish ver-
sion of the Oswestry Disability Index for patients with low back
pain. Spine (Phila Pa 1976) 2004;29:581–585; discussion 585.
12. Vigatto R, Alexandre NM, Correa Filho HR. Development
of a Brazilian Portuguese version of the Oswestry Disability
Index: cross-cultural adaptation, reliability, and validity.
Spine (Phila Pa 1976) 2007;32:481–486.
13. STarT Back [Internet]. University of Keele. 9 February
2016. http://www.keele.ac.uk/sbst/ (9 February 2016, date
last accessed).
14. Walsh TL, Hanscom B, Lurie JD, Weinstein JN. Is a con-
dition-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 (Phila Pa 1976) 2003;28:607–615.

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