About the Oswestry Disability Index
The Oswestry Disability Index (ODI) is one of the principal condition-specific outcome measures used in the management of spinal disorders. It was first published in 1980 by researchers at the Oswestry Hospital and has since become the most commonly used outcome measure for low back pain. The questionnaire has been extensively tested, shown to be valid and reliable, and is now used worldwide in clinical practice and research. It assesses how back pain affects your ability to manage in everyday life across 10 key areas including pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and travelling.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
Developed by Dr Jeremy Fairbank and colleagues at the Oswestry Hospital in Shropshire, England, in collaboration with the Medical Research Council's Epidemiology Unit at Cardiff. The original questionnaire was first published in 1980 and has undergone minor modifications since then, with the most commonly used version being that published in 2000.
Copyright & Licensing
The Oswestry Disability Index is in the public domain and free to use for clinical and research purposes. No permission or licensing is required to use the questionnaire. However, any modifications to the original questionnaire should be avoided to maintain its validated psychometric properties. Users should cite the original publications when reporting results.
Administration Instructions
Select the one statement in each section that best describes you today. If multiple statements apply, choose the one that most closely matches your condition. Answer based on how you feel right now.
Scoring Methodology
The ODI consists of 10 sections, each containing 6 statements that describe increasing levels of disability, scored from 0 (no disability) to 5 (maximum disability). Patients select the one statement in each section that best describes their current condition. If a section is not applicable or is not answered, it is excluded from the calculation. The score is calculated as: (Sum of all answered sections / (Number of answered sections × 5)) × 100. This gives a percentage score where 0% represents no disability and 100% represents maximum disability. For example, if a patient completes all 10 sections and scores a total of 16 points, the calculation would be: (16 / 50) × 100 = 32%.
Meaningful Change Threshold
The minimum clinically important difference (MCID) for the ODI is generally accepted to be 10 percentage points. This means a change of 10% or more represents a meaningful improvement or deterioration in the patient's functional status. Some studies suggest the MCID may range from 8 to 15 percentage points depending on the baseline severity and population studied. A change of 20% or more is considered a substantial clinical improvement.
Score Interpretation
Understanding what your score means
minimal
0 - 20Minimal disability – The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting, posture, physical fitness, and diet. Patients with sedentary occupations should be able to work with this level of pain.
moderate
21 - 40Moderate disability – The patient experiences more pain and difficulty with sitting, lifting, and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity, and sleeping are not grossly affected and the patient can usually be managed by conservative means.
severe
41 - 60Severe disability – Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation and comprehensive treatment approach.
crippling
61 - 80Crippling back pain – Back pain impinges on all aspects of the patient's life. Positive intervention is required and may include pain management programs or surgical intervention.
bed bound
81 - 100Bed-bound or exaggerating symptoms – These patients are either bed-bound or exaggerating their symptoms. Careful assessment is required to distinguish between the two. If genuine, intensive pain management and surgical evaluation are typically indicated.
Clinical Limitations & Considerations
While the ODI is a widely validated and reliable measure, it has several limitations. The questionnaire is specifically designed for lower back pain and may not be appropriate for other spinal conditions or pain locations. Section 8 (Sex Life) may be culturally sensitive or not applicable to all patients, though this section can be omitted without invalidating the score. The ODI assesses disability rather than impairment and relies on patient self-report, which may be subject to bias. It provides a snapshot of disability at a single time point and may not capture the fluctuating nature of back pain. The ceiling and floor effects can occur in very mild or very severe cases. Additionally, the questionnaire does not assess psychological factors, which are known to be important in chronic low back pain.
Supporting Literature
Key validation and development studies for the Oswestry Disability Index
- 1
The Oswestry low back pain disability questionnaire
Fairbank JC, Couper J, Davies JB, O'Brien JP
Physiotherapy, 1980
- 2
Minimum Clinically Important Difference of the Oswestry Disability Index Score in Patients With Low Back Pain
Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY
Spine, 2008
- 3
Responsiveness of the Oswestry Disability Index Compared to the Roland Morris Disability Questionnaire in Patients with Low Back Pain
Davidson M, Keating JL
Journal of Manipulative and Physiological Therapeutics, 2005
- 4
Cross-cultural adaptation, reliability, validity and responsiveness of the Oswestry Disability Index in Brazil
Vigatto R, Alexandre NM, Correa Filho HR
Brazilian Journal of Medical and Biological Research, 2007
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