Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. 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. Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Outcome scores in spinal surgery quantified: excellent, good, fair and poor in terms of patient-completed tools No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises Outcome scores in degenerative cervical disc surgery Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke Effectiveness of mechanical diagnosis and therapy in patients with back pain who meet a clinical prediction rule for spinal manipulation Testing minimal clinically important difference: consensus or conundrum? The Reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the Assessment of Patients With Lumbar Spinal Stenosis Relationship of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) with three dynamic physical tests in a group of patients with chronic low-back and leg pain. A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial Beyond Minimally Important Change: Defining a Successful Outcome of Physical Therapy for Patients With Low Back Pain
BACKGROUND CONTEXT Lumbar pathology is often associated with axial pain or neurologic complaints . It is often presumed that such pain is associated with decreased lumbar motion ; however , this correlation is not well established . The utility of various outcome measures that are used in both research and clinical practice have been studied , but the connection with range of motion ( ROM ) has not been well documented . PURPOSE The current study was performed to assess objective ly the postulated correlation of lumbar complaints ( based on st and ardized outcome measures ) with extremes of lumbar ROM and functional ROM ( fROM ) with activities of daily living ( ADLs ) as assessed with an electrogoniometer . STUDY DESIGN / SETTING This study was a clinical cohort study . PATIENT SAMPLE Subjects slated to undergo a lumbar intervention ( injection , decompression , and /or fusion ) were enrolled voluntarily in the study . OUTCOME MEASURES The two outcome measures used in the study were the Visual Analogue Scale ( VAS ) for axial extremity , lower extremity , and combined axial and lower extremity , as well as the Oswestry Disability Index ( ODI ) . METHODS Pain and disability scores were assessed with the  VAS score and ODI . A previously vali date d electrogoniometer was used to measure ROM ( extremes of motion in three planes ) and fROM ( functional motion during 15 simulated activities of daily living ) . Pain and disability scores were analyzed for statistically significant association with the motion assessment s using linear regression analyses . RESULTS Twenty-eight men and 39 women were enrolled , with an average age of 55.6 years ( range , 18 - 79 years ) . The ODI and VAS were associated positively ( p<.001 ) . Combined axial and lower extremity VAS scores were associated with lateral and rotational ROM ( p<.05 ) , but not with flexion/extension or any fROM . Similar findings were noted for separately analyzed axial and lower extremity VAS scores . On the other h and , the ODI correlated inversely with ROM in all planes , and fROM in at least one plane for 10 of 15 ADLs ( p<.05 ) . CONCLUSIONS Extremes of lumbar motion and motions associated with ADLs are of increasing clinical interest . Although the ODI and VAS are associated with each other , the ODI appears to be a better predictor of these motion parameters than the VAS ( axial extremity , lower extremity , or combined ) and may be more useful in the clinical setting when considering functional movement parameters Study Design . Cross-cultural translation and psychometric testing were performed . Objectives . To cross-culturally translate the Oswestry Disability Index ( ODI ) , Rol and -Morris Disability Question naire ( RDQ ) , and Quebec Back Pain Disability Scale ( QDS ) into Persian , and then investigate the psychometric properties of the Persian versions produced . Summary of Background Data . To the authors ’ knowledge , there is no vali date d instrument to measure functional status in Persian-speaking patients with low back pain ( LBP ) in Iran . To our knowledge , the widely used back-specific measures , the ODI , RDQ , and QDS , have not been translated and vali date d for Persian-speaking patients with LBP . Methods . The translation and cross-cultural adaptation of the original question naires were performed in accordance with published guidelines . A total of 100 patients with chronic LBP were asked to complete a question naire booklet ( the Persian versions of the ODI , RDQ , QDS , Short Form Health Survey ( SF-36 ) , and visual analog scale measure of pain ) . There were 31 r and omly select patients with chronic LBP asked to complete the second question naire booklet 24 hours later . Results . The Cronbach-α for the ODI , RDQ , and QDS was 0.75 , 0.83 , and 0.92 , respectively . The ODI , RDQ , and QDS showed excellent test-retest reliability ( intraclass correlation coefficient = 0.91 , 0.86 , and 0.86 , respectively ) ( P < 0.01 ) . The correlation among the ODI , RDQ , QDS and physical functioning scales of the SF-36 was −0.66 , −0.62 , and −0.69 , respectively ( P < 0.001 ) . The correlation among the ODI , RDQ , and QDS and visual analog scale was 0.54 , 0.36 , and 0.46 , respectively ( P < 0.001 ) . Conclusions . The Persian versions of the ODI , RDQ , and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales , and the use of them can be recommended in a clinical setting and future outcome studies in Iran BACKGROUND CONTEXT Patient-based quality of life scales have become a critical element of post-op assessment for lumbar fusion surgery . The most extensive outcomes data have been generated through FDA -regulated IDE trials for new technologies , which produce excellent data but are constrained by strict enrollment criteria and limited indications . This raises a question as to whether the excellent results seen in these IDE trials can be reproduced in st and ard clinical practice . PURPOSE The purpose of this study was to analyze surgical results based upon st and ardized outcome tools , across a spectrum of interventions , for one- and two-level lumbar spine fusion procedures . DESIGN / SETTING This study is a retrospective review of prospect ively collected patient based outcomes data . PATIENT SAMPLE Four hundred ninety-seven patients , who underwent 1- or 2-level lumbar spine fusion at five participating spine centers , utilizing a variety of surgical techniques . Enrollment criteria included available demographic , surgical and clinical outcome data . At a minimum , patients had pre-op and one year post-op SF-36 data . In many cases two-year post-op SF-36 data and concomitant Oswestry Disability Index ( ODI ) data was available . OUTCOME MEASURES SF36 and ODI . METHODS The patient population included 270 females and 227 males , with a mean age of 47 years . Sixty-five percent ( N=324 ) had one level fusions and 35 % ( N=173 ) had two level fusions . Demographic data collected included age , gender , BMI , surgical history , smoking history and work status . Data was analyzed with repeated measures analysis of variance ( ANOVA ) . RESULTS SF-36 Physical Composite Score ( PCS ) improved a mean 9.9 points at one year post-op and 9.5 points at two years post-op . ODI improved a mean 22.2 points at one year post-op and 22.1 points at two years post-op . SF-36 PCS data for surgical approach subgroups revealed greater improvement ( p=.03 ) in the ALIF group as compared to the PSF , PLIF/TLIF , or 360 degrees fusion groups ( 12.6 points vs. 8.8 , 9.3 , 8.4 points ) at 1 year post-op . At 2 years post-op , there was greater improvement ( p=.02 ) in the ALIF and PSF groups as compared to the PLIF/TLIF and 360 degrees fusion groups ( 13.8 and 11.2 points vs. 7.7 and 6.3 points ) . SF-36 PCS data demonstrated similar baseline scores for patients with and without prior decompression , but a significantly greater rate of improvement ( 11.3 vs. 7.2 points , p=.002 ) for patients without prior lumbar decompression surgery . The ODI data indicated a significantly greater disability at baseline in the prior decompression group , with greater improvement ( 21.7 vs. 17.5 points ) in patients without prior surgery . CONCLUSIONS This study documents improved outcomes , based on SF-36 and ODI scores , in patients undergoing lumbar fusion for one and two level degenerative disc disease . The findings also demonstrate efficacy for all of the surgical techniques studied , suggesting that surgeons can appropriately select the surgical strategy with which they are most adept BACKGROUND CONTEXT The impact of  lumbar spinal surgery  is commonly evaluated with three patient-reported outcome measures : Oswestry Disability Index ( ODI ) , the physical component summary ( PCS ) of the Short Form of the Medical Outcomes Study ( SF-36 ) , and pain scales . A minimum clinical ly important difference ( MCID ) is a threshold used to measure the effect of clinical treatments . Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method . PURPOSE This study has three purpose s. First , to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID . Second , to determine a statistically sound and clinical ly meaningful MCID for ODI , PCS , back pain scale , and leg pain scale in lumbar spine surgery patients . Third , to compare the discriminative ability of two anchors : a global health assessment and a rating of satisfaction with the results of the surgery . STUDY DESIGN This study is a review of prospect ively collected patient-reported outcomes data . PATIENT SAMPLE A total of 454 patients from a large data base of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study . OUTCOME MEASURES Preoperative and 1-year postoperative scores for ODI , PCS , back pain scale , leg pain scale , health transition item ( HTI ) of the SF-36 , and Satisfaction with Results scales . METHODS ODI , SF-36 , and pain scales were administered before and 1 year after spinal surgery . Several c and i date MCID calculation methods were applied to the data and the result ing values were compared . The HTI of the SF-36 was used as the anchor and compared with a second anchor ( Satisfaction with Results scale ) . RESULTS Potential MCID calculations yielded a range of values : fivefold for ODI , PCS , and leg pain , 10-fold for back pain . Threshold values obtained with the two anchors were very similar . CONCLUSIONS The minimum detectable change ( MDC ) appears as a statistically and clinical ly appropriate MCID value . MCID values in this sample were 12.8 points for ODI , 4.9 points for PCS , 1.2 points for back pain , and 1.6 points for leg pain OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Outcome scores are very useful tools in the field of spinal surgery as they allow us to assess a patient ’s progress and the effect of various treatments . The clinical importance of a score change is not so clear . Although previous studies have looked at the minimum clinical ly important score change , the degree of score change varies considerably . Our study is a prospect i ve cohort study of 193 patients undergoing discectomy , decompression and fusion procedures with minimum 2-year follow-up . We have used three st and ard outcome measures in common usage , the oswestry disability index ( ODI ) , the  low back outcome score ( LBOS ) and the visual analogue score ( VAS ) . We have defined each of these scores according to a global measure of outcome grade d by the patient as excellent , good , fair or poor . We have also grade d patient perception and classified excellent and good as success and fair and poor as failure . Our results suggest that a median 24-point change in the ODI equates with a good outcome or is the minimum change needed for success . We have also found that different surgical disorders have very different minimal clinical ly important differences as perceived by patient perception . We found that for a discectomy a minimum 27-point change in the ODI would be classed as a success , for a decompression the change in ODI needed to class it as a success would be 16 points , whereas for a fusion the change in the ODI would be only 13 points . We believe that patient-rated global measures of outcome are of value and we have quantified them in terms of the st and ard outcome measures used in spinal surgery Purpose To compare the 9-year outcome in patients with chronic low back pain treated by  instrumented lumbar fusion  versus cognitive intervention and exercises . Methods The main outcome measure was the Oswestry Disability Index ( ODI ) . Secondary outcome measures included pain , fear-avoidance beliefs , trunk muscle strength , medication , and return to work . Results One-third of the patients r and omized to cognitive intervention and exercises  had crossed over and been operated and one-third of the patients allocated to lumbar fusion had been re-operated . The intention-to-treat analysis detected no differences between the two groups . The mean adjusted treatment effect for ODI was 1.9 ( 95 % CI −7.8 to 11.6 ) . Analysed according to the treatment received , more operated patients used pain medication and were out of work . Conclusions The outcome at 9 years was not different between instrumented lumbar fusion and cognitive intervention and exercises Abstract Forty-six consecutive patients with neck pain and arm radiculopathy were treated with anterior cervical discectomy and fusion . All patients had neurological symptoms corresponding to a herniated disc and /or spondylosis at one or two cervical levels , verified by magnetic resonance imaging . The patients were stabilized with an anterior graft and r and omized to either fixation with a CSLP plate or no internal fixation . Preoperatively and 2 years postoperatively the patients filled in a question naire that included a modified Million Index , a modified Oswestry Index and the Zung Depression Scale . They were also asked to register their pain in the arm and in the neck on a vertical visual analogue scale ( VAS ) . At the 2-year follow-up , an unbiased observer grade d the patients ’ clinical outcome using Odom ’s criteria . A test-retest procedure was carried out to examine the question naire reproducibility . In the group that was operated at one level , there was no significant improvement in any of the scores . Nevertheless , 81 % of the patients were satisfied with the outcome of the surgery . All scores improved in the group operated at two levels . The pain in the neck and arm , as measured on a VAS , decreased in both groups . The improvement in arm pain was significantly more pronounced in patients operated with a plate at two levels compared to those who were operated without a plate . At the 2-year follow-up , patients with an excellent or good result according to Odom ’s criteria had a lower Million Index ¶(P < 0.0005 ) , Oswestry Index ( P < 0.0005 ) , and Zung ( P = 0.024 ) score , than the group classified as fair or poor . There was a significant correlation ( P < 0.0001 for all scores ) between the test and retest results . We conclude that the modified Million Index and Oswestry Index are clinical ly useful tools in the evaluation of outcome after degenerative cervical disc surgery . The clinical benefits of plate fixation were minimal . The outcome after surgery , measured with the Oswestry Index , Million Index and VAS for arm and neck pain , seems to correlate well with the classification of outcome by Odom Purpose The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological ( CPP ) programme in chronic low back pain ( CLBP ) patients . Methods A prospect i ve cohort of 524 selected consecutive CLBP patients was followed . Potential predictive factors included demographic characteristics , disability , pain and cognitive behavioural factors as measured at pre-treatment assessment . The primary outcome measure was the oswestry disability index ( ODI ) . A successful 1-year follow-up outcome was defined as a functional status equivalent to ‘ normal ’ and healthy population s ( ODI ≤22 ) . The 2-week residential programme fulfills the recommendations in international guidelines . For statistical analysis we divided the data base into two equal sample s. A r and om sample was used to develop a prediction model with multivariate logistic regression . The remaining cases were used to vali date this model . Results The final predictive model suggested being ‘ in employment ’ at pre-treatment [ OR 3.61 ( 95 % CI 1.80–7.26 ) ] and an initial ‘ disability score ’ [ OR 0.94 ( 95 % CI 0.92–0.97 ) ] as significant predictive factors for a successful 1-year outcome ( R2 = 22 % ; 67 % correctly classified ) . There was no predictive value from measures of psychological distress . Conclusion CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme  are most likely to benefit from it and to have a successful treatment outcome . In these patients , the disability score falls to values seen in healthy population s. This small set of factors is easily identified , allowing selection for programme entry and triage to alternative treatment regimes Background The need for cost effectiveness analyses in r and omized controlled trials that compare treatment options is increasing . The selection of the optimal utility measure is important , and a central question is whether the two most commonly used indexes - the EuroQuol 5D ( EQ5D ) and the Short Form 6D ( SF6D ) – can be used interchangeably . The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties . The psychometric properties of the two utility indexes were compared to a disease-specific instrument , the Oswestry Disability Index ( ODI ) , in the setting of a r and omized controlled trial for degenerative disc disease . Methods In a r and omized controlled multicentre trial , 172 patients who had experienced low back pain for an average of 6 years were r and omized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses .  Patients filled out the ODI , EQ5D , and SF-36 at baseline and two-year follow up . The utility indexes was compared with respect to measurement error , structural validity , criterion validity , responsiveness , and interpretability according to the COSMIN taxonomy . Results At follow up , 113 patients had change score values  for all three instruments . The SF6D had better similarity with the disease-specific instrument ( ODI ) regarding sensitivity , specificity , and responsiveness . Measurement error was lower for the SF6D ( 0.056 ) compared to the EQ5D ( 0.155 ) . The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D . The minimal detectable change score value at a 95 % confidence level were 0.157 for SF6D and 0.429 for EQ5D , and the difference in mean change score values ( SD ) between them was 0.23 ( 0.29 ) and so exceeded the clinical significant change score value for both instruments . Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately , but that they do not exactly measure the same underlying construct . Conclusions This study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable . Since the similarity with the “ gold st and ard ” ( the disease-specific instrument ) was quite different , this could indicate that the choice of index should be determined by the diagnosis Background : St and ing is believed to have benefits in addressing motor and sensory impairments after stroke . One device to facilitate st and ing for severely disabled patients is the Oswestry St and ing Frame . Objective : To evaluate the effectiveness of the Oswestry St and ing Frame for severely disabled stroke patients . Design : A single centre , r and omized controlled trial . Setting : An inpatient stroke rehabilitation unit . Subjects : Patients were recruited if they had a clinical diagnosis of stroke , were medically stable and unable to achieve any score on the Trunk Control Test or unable to st and in mid-line without the assistance of two therapists . Intervention : The intervention ( n=71 ) and control ( n=69 ) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days ' treatment using the st and ing frame . Main outcome measures : The primary outcome measure was the Rivermead Mobility Index ( RMI ) . Secondary measures included the Barthel Index ; the Rivermead Motor Assessment ; the balanced sitting and sitting to st and ing components of the Motor Assessment Scale ; the Trunk Control Test and the Hospital Anxiety and Depression Scale . Blind assessment was undertaken at baseline , six weeks , 12 weeks and six months post stroke . Information on re source use was also collected . Results : There was no statistically significant difference between groups in any of the outcome measures or for re source use . Mann-Whitney U-tests for the RMI change from baseline scores to six weeks , 12 weeks and six months post stroke were p=0.310 ; p=0.970 and p=0.282 , respectively . Conclusion : Use of the Oswestry St and ing Frame did not improve clinical outcome or provide re source savings for this severely disabled patient group Abstract Recently a clinical prediction rule ( CPR ) for lumbar regional spinal thrust manipulation ( STM ) has shown predictive success in patients with back pain who met specific selection criteria . The purpose of this study was to compare the effectiveness of  STM  and mechanical diagnosis and therapy ( MDT ) in patients who are positive for the STM CPR . Following initial examination , 31 participants were r and omized to the STM group ( n = 16 ) and to the MDT group ( n = 15 ) . Two weeks following initial examination , four participants chose to cross over from the STM group to the MDT group . The Oswestry Disability Index ( ODI ) , Fear-Avoidance Beliefs Question naire work subscale ( FABQw ) , and the Numerical Pain Rating Scale ( NPRS ) were administered initially , and at 2-weeks and 4 week follow-up ( discharge ) . Data were analyzed to determine changes in ODI and NPRS scores from initial examination through one month . Of the 31 participants , one patient who met only three of five selection criteria and four others who chose to switch groups were removed from the analysis . Both groups exhibited statistically significant improvements in ODI and NPRS scores from baseline to final visit but there was no significant difference in scores between groups at 4 weeks . In this sample of patients , the selection criteria for this CPR were not exclusive for lumbopelvic STM . Mechanical diagnosis and therapy was an equally viable choice for these patients BACKGROUND CONTEXT Various method ologies have been used in attempting to eluci date a st and ard method for calculating minimal clinical ly important difference ( MCID ) . A consensus-based decision ( Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials [ IMMPACT ] group ) suggested a 30 % reduction from baseline as a means to define the MCID of self-report back pain measures . Additionally , important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion , instead of simply using another self-report measure , when using an anchor-based approach to MCID . PURPOSE The purpose was to test the validity of recently published guidelines regarding MCID using self-report back pain measures and objective socioeconomic outcomes . STUDY DESIGN / SETTING This is a prospect i ve study assessing change scores on commonly used spinal pain assessment measures in patients with chronic disabling occupational spinal disorders ( CDOSDs ) treated in a regional referral rehabilitation center performing interdisciplinary functional restoration . PATIENT SAMPLE The study consisted of consecutive cohort of patients ( N=1,180 ) with CDOSDs completing a functional restoration program . OUTCOMES MEASURES Self-report measures including the Oswestry Disability Index ( ODI ) and the physical component summary ( PCS ) and mental component summary ( MCS ) of the Short Form-36 ( SF-36 ) obtained before and after treatment , were compared with objective socioeconomically relevant outcomes obtained 1 year after treatment ( ie , work status and additional health-care utilization ) , that were the external criteria for evaluating MCID . METHODS Pre- to posttreatment improvement was calculated separately for each measure , and subjects were divided into two groups based on the change in scores relative to baseline : 30 % or greater versus less than 30 % improvement . One-year posttreatment objective socioeconomic outcomes were used as independent external criteria relevant to the CDOSD population . This population is often studied as the most costly and problematic cohort in spine care . RESULTS The ODI and SF-36 MCS were not associated with any of the objective 1-year outcomes used as external criteria . Reduced post-rehabilitation health-care utilization ( based on the percentage of patients pursuing health care from a new provider ) was weakly associated with 30 % or greater improvement on the SF-36 PCS , relative to patients whose scores changed by less than 30 % relative to baseline ( 17.0 % vs. 21.1 % ) . The same was true for the ODI and return-to-work . CONCLUSIONS When objective and independent criteria are used ( socioeconomic outcomes ) in a CDOSD cohort , the 30 % improvement in the ODI and SF-36 may not be a valid MCID index . This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID . The validity of the MCID concept rests on future research using objective external criteria . Moreover , there remains a question whether the term " important " in MCID can be unequivocally and operationally defined as a reliable construct Study Design . The Shuttle Walking Test ( SWT ) , the Swiss Spinal Stenosis ( SSS ) Question naire , the Oxford Claudication Score ( OCS ) , and the Oswestry Disability Index ( ODI ) were administered to patients with lumbar spinal stenosis and neurogenic claudication . Objective . To determine reliability of the SWT , the SSS ( Q1–12 ) , the OCS , and the ODI in lumbar spinal stenosis assessment . Summary of Background Data . Reliability data for exercise tests in lumbar spinal stenosis are lacking . Methods . To determine reliability , 32 clinic patients with lumbar spinal stenosis were assessed twice , with 1 week between assessment s. Retrospective data from 17 patients assessed before surgery and 18 months after surgery for lumbar spinal stenosis were used to investigate the use of reliability in a clinical setting . Results . Test – retest reliability in terms of the intraclass correlation coefficient ( ICC ) was 0.92 for the SWT , 0.92 for the SSS , 0.83 for the OCS and 0.89 for the ODI . The mean percentage scores were 51 for the SSS , 45 for the OCS , and 40 for the ODI . To achieve 95 % certainty of change between assessment s for a single patient , the SSS would need to change by 15 , the OCS by 20 , and the ODI by 16 . The mean SWT was 150 m , with a change of 76 m required for 95 % confidence . Cronbach ’s alpha was 0.91 for the SSS , 0.90 for the OCS , and 0.89 for the ODI . The change in ODI correlated most strongly with patient satisfaction after surgery ( & rgr ; = 0.80;P < 0.001 ) . Conclusions . Fluctuations in a patient ’s symptoms result in wide individual confidence intervals . Performance on the SSS , OCS , and ODI question naires are broadly similar , the most precise being the condition-specific SSS . The SWT gives a snapshot of physical function , which is acceptable for group analysis . Use of the SWT for individual assessment after surgery is feasible OBJECTIVE To determine the relationship between overall disability in daily activities , assessed with the Pain Disability Index ( PDI ) and the Oswestry Disability Question naire ( ODQ ) , and impaired performance on three physical tests in patients with chronic low-back pain . DESIGN AND SUBJECTS The PDI and ODQ were administered in a cross-sectional study , before beginning a back rehabilitation program , to 45 patients with low-back pain of > or = 3 months ' duration , with or without radiation to the legs . All patients also performed repetitive sit-up , arch-up , and squatting tests . SETTING Tertiary care center . RESULTS Modestly significant ( p < 0.05 ) or significant ( p < 0.01 ) inverse correlations ( Pearson 's r = 0.30 - 0.41 ) were noted between the PDI and the ODQ and all three physical performance tests . When normative data were used , the correlation ( Spearman 's rs = -0.45 ) between PDI and the squatting test remained significant ( p < 0.01 ) , whereas it was modestly significant ( rs = -0.33 , p < 0.05 ) between the ODQ and squatting test and between the PDI and arch-up test ( rs = -0.35 , p < 0.05 ) . Compared with patients presently working , those on sick leave had significantly higher scores on the PDI and ODQ ( Wilcoxon 's two- sample test : p < 0.001 ) and also significantly worse performance on all physical tests ( p < 0.001 ) . CONCLUSIONS The PDI and ODQ , as measures of self-perceived disability , and impaired performance on repetitive squatting , arch-up , and sit-up tests , as measures of physical capability , show some overlap in low-back-pain patients . Both types of disability measures are clearly influenced by the patient 's work status & NA ; The aim of this study was to assess the long‐term effect of a supervised fitness programme on patients with chronic low back pain . The design of the study was a single blind r and omised controlled trial with follow‐up , by postal question naire , 2 years after intervention . The Oswestry Low Back Pain Disability Index was used as the outcome measure to assess daily activity affected by back pain . Eighty‐one patients with chronic low back pain , who were referred to the physiotherapy department of a National Health Service orthopaedic hospital , were r and omised to either a supervised fitness programme or a control group . Patients in the intervention group and control group were taught specific exercises to be continued at home and referred to a backschool for back care education . In addition , the intervention group attended eight sessions of a supervised fitness programme .  Sixty‐two patients ( 76 % ) with a mean age of 37 years , returned the Oswestry Low Back Pain Disability Index question naire . Of these , 29 were in the intervention group and 31 in the control group . Patients in the intervention group demonstrated a mean reduction of 7.7 % in the Oswestry Low Back Pain Disability Index score ( 95 % confidence interval of mean paired difference 3.9 , 11.6 P<0.001 ) , compared with only 2.4 % in the control group ( 95 % confidence interval of mean paired difference −2.0 , 6.9 P>0.05 ) . Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group ( mean difference 5.8 , 95 % confidence interval 0.3 , 11.4 P<0.04 ) . This study supports the current trend towards a more active treatment approach to low back pain . We have demonstrated clinical effectiveness of a fitness programme 2 years after treatment but this needs to be replicated in a larger study which should include a cost effectiveness analysis , further analysis of objective functional status and a placebo intervention group Study Design . Prospect i ve , longitudinal cohort study Objective . To examine the validity of a threshold that has been used to define a successful outcome for patients with low back pain ( LBP ) , undergoing nonsurgical rehabilitation based on a 50 % improvement on the Modified Oswestry disability index ( ODI ) .  Summary of Background Data . Making research findings interpretable is a goal of evidence -based practice . One attempt to improve interpretability is reporting treatment results as the percentage of patients achieving a threshold level of improvement within treatment groups along with mean between-group differences . The most recommended threshold is the minimum clinical ly important difference of the outcome tool . For clinical conditions with favorable natural histories such as LBP , thresholds requiring more than minimal improvement may be preferable for defining success . Methods . Patients with LBP receiving 4 weeks of physical therapy  were examined . The ODI and measures of pain , fear-avoidance beliefs , and demographic characteristics were recorded at baseline and after treatment . A 15-point global rating of change was also completed after treatment . The percent ODI change with treatment was computed and compared between groups known to have different prognoses . The percent ODI change was compared to the global rating of change to determine the accuracy of various thresholds of success based on the percent ODI change . Results . A total of 243 subjects ( mean age 37.2 ± 11.4 years , 44.9 % female ) were included . Mean percent ODI change was 43.1 % ( ±40.5 ) , and 109 subjects ( 44.9 % ) had a successful outcome ( ≥50 % ODI improvement ) . As hypothesized , baseline factors with known prognostic importance were less likely to be present in subjects with a successful outcome . The 50 % ODI improvement threshold for success had high sensitivity ( 0.84 ; 95 % CI : 0.79 , 0.88 ) and specificity ( 0.89 ; 95 % CI : 0.85 , 0.93 ) when compared with success based on the global rating of change . No other percent improvement threshold for the ODI had a higher accuracy than the 50 % threshold when compared to the global rating of change . Conclusion . A threshold of 50 % improvement on the ODI may be a valid measure for defining a successful outcome for patients with LBP
These data provide both validation and st and ards for other users and indicate the power of the instrument for detecting change in sample population s. CONCLUSIONS The  ODI  remains a valid and vigorous measure and has been a worthwhile outcome measure .
The behavior of the instrument is incompletely understood , particularly in sensitivity to real change
STUDY DESIGN The Oswestry Disability Index ( ODI ) has become one of the principal condition-specific outcome measures used in the management of spinal disorders .
This review is based on publications using the ODI identified from the authors ' personal data bases , the Science Citation Index , and h and search es of Spine and current textbooks of spinal disorders .
OBJECTIVES To review the versions of this instrument , document methods by which it has been vali date d , collate data from scores found in normal and back pain population s , provide curves for power calculations in studies using the ODI , and maintain the ODI as a gold st and ard outcome measure .
SUMMARY OF BACKGROUND DATA It has now been 20 years since its original publication .
More than 200 citations exist in the Science Citation Index .