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The Oswestry Disability Index, confirmatory factor analysis in a sample of 35,263 verifies a one-factor structure but practicality issues remain

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Abstract

Purpose

To analyze the factor structure of the Oswestry Disability Index (ODI) in a large symptomatic low back pain (LBP) population using exploratory (EFA) and confirmatory factor analysis (CFA).

Methods

Analysis of pooled baseline ODI LBP patient data from the international Spine Tango registry of EUROSPINE, the Spine Society of Europe. The sample, with n = 35,263 (55.2% female; age 15–99, median 59 years), included 76.1% of patients with a degenerative disease, and 23.9% of the patients with various other spinal conditions. The initial EFA provided a hypothetical construct for consideration. Subsequent CFA was considered in three scenarios: the full sample and separate genders. Models were compared empirically for best fit.

Results

The EFA indicated a one-factor solution accounting for 54% of the total variance. The CFA analysis based on the full sample confirmed this one-factor structure. Sub-group analyses by gender achieved good model fit for configural and partial metric invariance, but not scalar invariance. A possible two-construct model solution as outlined by previous researchers: dynamic-activities (personal care, lifting, walking, sex and social) and static-activities (pain, sleep, standing, travelling and sitting) was not preferred.

Conclusions

The ODI demonstrated a one-factor structure in a large LBP sample. A potential two-factor model was considered, but not found appropriate for constructs of dynamic and static activity. The use of the single summary score for the ODI is psychometrically supported. However, practicality limitations were reported for use in the clinical and research settings. Researchers are encouraged to consider a shift towards newer, more sensitive and robustly developed instruments.

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Acknowledgements

The participants of the Spine Tango Register are acknowledged for their continuous contribution that makes possible such studies reflecting the daily practise of spine surgeons. The data of the following centres were used (in alphabetic order of country, city, hospital and department): Dept. of Spinal Surgery in Royal Adelaide Hospital (Australia); Dept. of Spinal Surgery in St. Andrew’s Hospital in Adelaide (Australia); Dept. of Orthopaedic Surgery in Landesklinikum Krems (Austria); Dept. of Orthopaedic Surgery in Orthopaedic Hospital Speising in Vienna (Austria); Dept. of Orthopaedic Surgery in University Hospital St. Luc in Brussels (Belgium); Dept. of Orthopaedic Surgery in Grand Hôpital de Charleroi (Belgium); Dept. of Neurosurgery in University Hospital Cologne (Germany); Dept. of Orthopaedic Surgery in University Hospital of Cologne (Germany); Dept. of Spine Surgery in Hospital Dortmund (Germany); Dept. of Orthopaedic Surgery in University Hospital of Greifswald (Germany); Dept. of Spine Surgery and Neurotraumatology in St. Nobifacius Hospital Lingen (Germany); Dept. of Neurosurgery in Orthopädisches Klinikum Markgröningen (Germany); Dept. of Neurosurgery in Klinikum Offenbach (Germany); Dept. of Orthopaedic Surgery in Asklepios Klinikum Uckermark in Schwedt (Germany); Dept. of Special Spine Surgery in Leopoldina Hospital of Schweinfurt (Germany); Dept. of Spine Surgery in Krankenhaus der Barmherzigen Brüder in Trier (Germany); Dept. of Spine Surgery in Clinica Cellini (Italy); Dept. of Spine Surgery in IRCCS Galeazzi in Milan (Italy); Dept. of Neurosurgery in Sapienza University of Rome (Italy); Dept. of Spine Surgery in Centro Medico Puerta de Hierro (Mexico); Dept. of Spine Surgery in SCTO in Chisinau (Moldova); Dept. of Neurosurgery in Wojewódzki Szpital Specjalistyczny nr 2 in Jastrzębie-Zdrój (Poland); Dept. of Neurosurgery in Specialized Medical Center S.A. Polanica (Poland); Dept. of Neurosurgery in Medical University Silesia (Poland); Dept. of Neurosurgery in General Hospital Torun (Poland); Dept. of Orthopaedic Surgery and Traumatology in Kliniczny in Wroclaw (Poland); Dept. of Orthopaedic Surgery in Tan Tock Seng Hospital (Singapore); Dept. of Orthopaedic Surgery in University Hospital of Ljubljana (Slovenia); Dept. of Neurosurgery in Bethesda Hospital of Basel (Switzerland); Dept. of Spine Surgery in Bethesda Hospital of Basel (Switzerland); Dept. of Orthopaedic Surgery in Salem Hospital of Bern (Switzerland); Dept. of Spine Surgery in University Hospital in Lausanne (Switzerland); Dept. of Spine Surgery in Hirslandenklinik Birshof in Münchenstein (Switzerland); Dept. of Spine Surgery in The Spine Center Thun (Switzerland); Dept. of Orthopaedic Surgery in Hospital Schwyz (Switzerland); Dept. of Spine Surgery in Nottingham University Hospitals NHS Trust (UK); Spine Unit of Nuffield Oxford Centre (UK); Division of Orthopaedic Surgery in SUNY Downstate Medical Center in New York (USA); Division of Spine Surgery in NYU Hospital of New York (USA).

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Correspondence to Meihua Qian.

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Gabel, C.P., Cuesta-Vargas, A., Qian, M. et al. The Oswestry Disability Index, confirmatory factor analysis in a sample of 35,263 verifies a one-factor structure but practicality issues remain. Eur Spine J 26, 2007–2013 (2017). https://doi.org/10.1007/s00586-017-5179-3

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  • DOI: https://doi.org/10.1007/s00586-017-5179-3

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