Oswestry Low Back Pain Disability Questionnaire Authors: J. C. Fairbanks, J. Couper, J. B. Davies, and J. P.

OBrien Purpose of tool: The purpose of the Oswestry Low Back Pain Disability Questionnaire (Oswestry Disability Index) is to assess pain-related disability in persons with low back pain (LBP). Target population: The target population for the Oswestry is acute, subacute, and chronic back pain client groups; various conservative, surgical, and behavioral intervention groups.2 What it tests: The Oswestry tests pain-related disability in patients with low back pain by way of a questionnaire. Reliability of test: Internal consistency: Cronbachs alpha: 0.71 to 0.871 Interrater: Not applicable2 Test-Retest: In the original study, patients with LBP were tested twice at a 24hour interval (n = 22, r = 0.99). If the test retest interval is extended to 4 days, the correlation of scores decreases to n = 22, r = 0.91, and after a week n = 22, r = 0.83. The memory effect may be the reason for the higher correlation scores after one day. A natural symptom fluctuation may be an influence in decreasing the correlation scores over the week period.1 Validity of test: Content: No reference to content validity in the literature.2 Criterion: No gold standard exists for the construct being measured.2 Construct-Cross-sectional2: Convergent correlations: Quebec Back Pain Scale: 0.80 Roland-Morris Questionnaire (RMQ): 0.82 Jan van Breeman (JVB) pain and function: 0.62 Known groups: Medication use (yes/no) effect size = 1.00 Work absence (yes/no) effect size = 0.89 Compensation (yes/no) = 0.85 Radiculopathy (yes/no) 49.6 versus 33.0 (p < 0.0001) Discriminant: Not available Construct- Longitudinal/Sensitivity to Change2: Convergent correlations: Correlation with global rating of change: 0.31 to 0.57 Correlation with RMQ change scores: 0.79 Correlation with JVB change scores: 0.61 (pain) to 0.64 (function) Known Groups: Important change (yes/no) receiver operating characteristic curve area: 0.76 and 0.78

Discriminant: Not available Other Validity Coefficients2: Effect size: 0.65 This test has also been tested against a visual analogue scale (n = 94, r = 0.62) and the McGill Pain Questionnaire.1 It has been used to validate the following tests: the Pain Disability Index, the Low Back Outcome Score, Manniche, the Aberdeen score, the new German language scale, Curtin Scale, and a functional capacity evaluation.1 ODI correlates with the Short Form (SF)36 and is a better predictor of return to work than two different mechanical methods of lumbar spine assessment.1 It also predicts isokinetic performance, isometric endurance, and pain with sitting and standing (but not lifting). Physical tests correlate with the ODI but range of motion does not.1 Administration: This test is a self-administered questionnaire. All that is needed to complete the test is the questionnaire and a writing utensil2. Time required: Most clients can complete the test in less than five minutes and it takes less than a minute to score the test even without the use of a computational aid2. Advantages: This test is widely used by physical therapists for determining functional disability due to low back pain and is simple, quick, and inexpensive to administer. Modified versions of the Oswestry have been developed but studies have shown that the original has the best measurement properties2. This test is also often used as an outcome measure in research on low back pain. Limitations: One limitation of this test is that it is subjective; ultimately, there is no absolute measure of disability due to pain. One downside of this test is that patients tend to leave questions blank. It is important that all the questions are answered for scoring purposes. Double-barreled questions also may be a source of confusion for the patients. Ordering/Acquisition information: This test is easy to access online by searching the terms Oswestry Low Back Pain Disability Questionnaire. The only costs of the test are copies of the questionnaire and writing utensils. References: 1. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25:2940-2953. 2. Firch E, Brooks D, Stratford P, Mayo N. Physical Rehabilitation Outcome Measures. Second ed. Hamilton, ON: BC Decker Inc; 2002:186-187. 3. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001;81:776-788. Appraised by: Katy Rice Date appraised: July 31, 2008