Clinical updatePsychometric properties and clinical usefulness of the Oswestry Disability Index
Introduction
Clinical decision making relies on valid and reliable outcome measures. Outcome measures determine clients' disability and impairment, choice of therapy, and degree of change over time. To be clinically meaningful, an outcome measure must be easy to complete and score, valid, reliable, and responsive.1
The Oswestry Disability Index (ODI) is one of the most commonly used outcome measures for individuals with low back pain (LBP)2, 3, 4 The ODI is a self-administered questionnaire that requires 5 minutes to complete and 1 minute to score. Scores are associated with degree of disability ranging from minimal to bedbound. The ease of administering, scoring, and interpreting renders the ODI a potentially meaningful tool in clinical practice.
Psychometric characteristics (validity, reliability, and responsiveness) of the ODI are the final determinants of the questionnaire's suitability as a clinically useful measure. Validity expresses the ability of a tool to measure what it intends to measure, whereas reliability describes a tool's ability to be consistent, to have small errors of measurement, and to differentiate among clients.5 A valid and reliable outcome measure is clinically relevant only if it possesses the ability to assess change over time (sensitivity to change).5 Even more clinically meaningful is the measurement of change over time that is important to clients (responsiveness).5
The determination of the appropriateness of the ODI as an outcome measure used to direct clinical decision making requires a critical review of its psychometric properties, interpretability, and burden of administration.
Section snippets
Methods
A search of the literature was performed using the key words disability evaluation, and low back pain, and questionnaires, and reproducibility of results, and the term Oswestry. The search was performed on Medline, CINAHL, EMBASE, and MANTIS. The search engines were selected for their relevance to the musculoskeletal field. The search yielded 27 citations of which 12 were not duplicates. Citations were kept if direct reference regarding psychometric property, interpretability, and burden was
Results
The ODI's psychometric properties have been well established. The ODI correlates with other outcome measures aiming at measuring disability due to LBP.1, 2, 3, 4,7 Validation of the Pain Disability Index, the Low Back Outcome Score, the Manniche Scale, the Aberdeen Score, the Curtin Scale, and a functional capacity evaluation was performed with the ODI.2, 3 Therefore, the ODI shows good construct validity because it is consistent with some and was used as the standard of comparison for other
Discussion
The ODI is a valid, reliable, and responsive condition-specific assessment tool that has withstood the test of time and scrutiny.3 So far, it has been used mostly in chronic and severely disabled populations, but shows good indicators for the assessments of less severe complaints.2
Administration burden is small. The questionnaire takes 5 minutes to complete and less than 1 minute to score.3, 6 The suggested time interval for readministration of the ODI is 6 weeks.6 The scoring system is well
Conclusion
The ODI is an acceptable tool to measure disability caused by LBP in the general population. The measurement of disability is an important part of LBP's assessment and management. The choice of the most appropriate outcome measure should rely on the nature of the condition, the type of data desired by the clinician, and environmental factors. The ODI is well suited for use in busy clinical settings that focus on the assessment of impacts caused by chronic LBP or gains after interventions. It is
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