Oswestry Disability Index

## **The leading cause of disability worldwide** The World Health Organization has deemed lower back pain as the leading cause of disability worldwide. They have released a statistic showing that, in 2020, 619 million people all over the globe have lower back pain, and by 2050, there will be at least 843 million cases (World Health Organization, 2023). Lower back pain can lead to difficulty moving, which will negatively affect a person's quality of life, both physical and mental. This can affect a person's working life in ways that they might not be able to perform the tasks they need to do, and if they can't do the tasks they need to do, they might get laid off by their employer. It can also affect their social lives and limit their engagement with family and friends. It can also prevent them from doing activities of daily living and other activities they have to do or would like to do.

## **What is the Oswestry Disability Index?** The Oswestry Disability Index, also known as the Oswestry Low Back Pain Disability Questionnaire or Oswestry Pain Disability Scale, is a ten-section questionnaire and one of the valuable outcome measures created to help healthcare practitioners assess the impact of lower back pain on daily activities, including evaluating pain intensity, especially when undergoing rehabilitation. It is a test known for its clinical usefulness and the following (Vianin, 2008): - It has a high internal consistency (0.71 to 0.87, depending on the various researchers who've examined this tool - It has high test-retest reliability and stability (0.83 to 0.99, depending on the length of the time intervals between conducting each test) - It has high responsiveness Orthopedic doctors/assistants, physical therapists, physiatrists, and even chiropractors who treat patients with lower back pain can use ODI, especially during the first face-to-face appointment or through a telehealth system. Lower back pain should be taken seriously and addressed as soon as possible, given that it could hinder a person from doing activities of daily living. This can also be used to assess patients periodically during their lower back rehabilitation program to gauge their progress. Not only does the Oswestry Disability Index have a clear purpose, but it also provides several benefits to the healthcare professionals who use it. Here's a list of some of them: - Provides a subject measure for a person's low back pain: By having score ranges and designations per range, the index gives the healthcare practitioner something to work with when gauging the patient and developing care plans for them. - It is a good way to track the progress of your patient and your care plan: Once your patient has started to undergo treatment based on your plan and/or they are (also) going through rehabilitation, you may reuse this index to help you monitor your patient's progress. - It is a good way to communicate to patients what they should avoid doing: Given that the patient will be the one ticking the answers on the index, they will be able to properly reflect on their current capabilities based on how limited they feel because of their lower back pain. It'll give them an idea of what they should not do. Now, please note that this tool only examines the disability cause by the lower back pain. It doesn't trace the origins of it, so you're going to have to rely on other tools and tests to get to the root of the problem. ### **What to expect when using this index** The sections themselves are the activities of daily living, such as personal care, walking, sitting, standing, and even weightlifting! Each section has six items describing potential scenarios in the patient's life relating to the subjects for each section. Do they not feel any pain at all when doing a particular activity? Can they still do that activity but feel a bit of pain? Or does the pain prevent them from doing that activity at all? These are the general questions that will be answered by engaging with the ten sections of this index. ### **How does it differ from the Modified Oswestry Disability Index?** There also exists a modified version of the Oswestry Disability Index called the Modified Oswestry Pain Disability Index. It is almost identical to the original, with the only difference being that it replaces a certain section. The section being referred to is the one that revolves around sexual activity and sex life, which is a touchy subject made even more touchy given the context of lower back pain, so some people are uncomfortable when it comes to answering. Many people who answer the original version usually leave that section blank. As an alternative, in the modified version, that section was replaced with Work/Homemaking, so people have no reason not to answer everything.

## **How to use the Oswestry Disability Index (ODI)** Now that you know how useful this index is, you can use it for your work! ### **Step 1: Download our template** Our template comes in a PDF file format. You only need to click "Use Template" or "Download" to obtain the file. It has interactive components, so you can use it digitally if you've gone paperless. Or, you can still print it, if you wish! ### **Step 2: Hand your patient a copy, or interview them** The Oswestry Disability Index is a self-administered questionnaire, meaning the patient will be the one to fill out the test's fields and tick the ratings they will give themselves. If, for some reason, they are unable to answer this themselves, you can conduct the test like an interview. Just make sure they have been well informed about the test and what answer choices they have for each item. ### **Step 3: Calculate and interpret the scores, then next steps** After your patient accomplished the test, or after you've ticked their self-ratings for them, all you need to do is to calculate the scores, interprete how negatively impacted they have been by lower back pain, then proceed with the next steps. Read the next sections to learn more about scoring the test, interpreting the scores, and the potential next steps.

## **Oswestry Disability Index scoring system** The Oswestry Disability Index is simple and straightforward, so you don't have to worry about anything complicated. All you need to do is explain what this outcome measure is all about, then have your patients answer it by having them tick the appropriate statement that applies to them. Once they're finished, it's time for you to get the score. Each section has six items arranged by severity. The first item signifies no pain when they do the activity, while the last item always signifies that they cannot perform or engage in the activity because the pain completely prevents them from doing so. Each section can score between 0 to 5 points. The first statement is always 0. The last statement is always 5. To calculate the scores, follow this equation: the total score ÷ the total possible score (always 50) x 100. Here's an example: - The total score is 16. - The total possible score is always 50. - Then the equation is 16 ÷ 50 x 100 = 32. - The final answer is always a percentage, so it's 32% in this case Now, after calculating the scores, refer to this scoring range chart and their designations to help you interpret the scores: - 0-20% indicates minimal disability. - 21-40% indicates moderate disability. - 41-60% indicates severe disability. - 61% - 80% indicates crippling effects. - 80% - 100% indicates that the patient is completely disabled and bed-bound (this is the most severe disability). It is also important to understand the minimum clinically important difference (MCID) when interpreting these scores. The MCID represents the smallest change in a score that patients perceive as important, particularly concerning the Oswestry Disability Questionnaire and its utility for evaluating different types of back pain and spinal surgeries.

## **Next steps** Once you have calculated the total and determined which percentage range it falls under, you can do use other similar tests like the Roland Morris Disability Questionnaire. You can use other tests to get to the bottom of certain problems, like using a pain questionnaire or conducting tests that narrow down the potential causes of the lower back pain. You can also formulate a care plan for low back pain patients. Consider the specific answers they ticked for each section to help you determine the most important things your care plan should address. If the patient reports leg pain, ensure the care plan addresses both back and leg pain to manage their condition effectively, like undergoing physical therapy and taking certain medicines. You can use the Care Plan Template to create personalized strategies for managing various health conditions, including those assessed using the Oswestry Disability Index Template. This index helps quantify the degree of disability and pain in individuals with back problems. Integrating the results from the Oswestry Disability Index into the care plan can enhance treatment outcomes and tailor interventions to the specific needs of the patient.

## **References** World Health Organization. (2023, June 19). Low back pain. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/low-back-pain ‌Vianin, M. (2008). Psychometric properties and clinical usefulness of the Oswestry Disability Index. Journal of Chiropractic Medicine, 7(4), 161–163. https://doi.org/10.1016/j.jcm.2008.07.001