Oswestry Disability Index (ODI)
A 10-section self-reported questionnaire measuring how much back pain limits daily life.
By Claire White
- Self-administered. It takes 3.5 to 5 minutes to complete and about a minute to score.
- 10 sections, each with six statements scored 0 to 5. The maximum raw score is 50.
- The total is reported as a percentage, where a higher percentage means more disability.
What does the ODI measure?
The ODI asks about ten areas of daily life that back pain interferes with. Each section offers six statements, from no limitation to maximum limitation, and the person picks the one that fits today.
- Pain intensity
- Personal care
- Lifting
- Walking
- Sitting
- Standing
- Sleeping
- Sex life, if applicable
- Social life
- Travelling
The point is function rather than pathology. Two people with the same scan can score twenty points apart, because the questionnaire asks what they can still do rather than what the imaging shows.
What does an ODI score mean?
The total is reported as a percentage from 0 to 100, where higher means more disability. The percentage maps to five published bands.
| Percentage | Band |
|---|---|
| 0 to 20 | Minimal disability |
| 21 to 40 | Moderate disability |
| 41 to 60 | Severe disability |
| 61 to 80 | Disability that significantly restricts daily activities |
| 81 to 100 | Bed bound, or symptoms may be exaggerated |
The band on its own is less useful than the change. An international consensus on low back pain outcomes proposed 10 points as the minimal important change, or a 30 percent change from baseline. In lumbar spine surgery, a study of 454 patients at one year put the threshold at 12.8 points. The score is reference information for the care team, tracked over time.
How the ODI is administered
- Administered by
- Self-administered. Also used over the telephone.
- Time to administer
- 3.5 to 5 minutes to complete, about a minute to score
- Equipment
- The questionnaire and a pen
- Cost
- Free to take here.
- Training required
- None
- Age range
- Adults
- Available languages
- Four English versions and nine in other languages, as counted by Fairbank and Pynsent in 2000
Related instruments
- EQ-5DThe generic companion. Spine studies and registries report the ODI and the EQ-5D side by side
- Spinal Cord Independence Measure (SCIM)Independence after spinal cord injury, where the question is what a person can do rather than what pain stops them doing
- Barthel IndexA shorter and older measure of independence in everyday activities, used across conditions
ODI questions, answered
How is the ODI scored?
Each of the ten sections offers six statements. The first scores 0 and the last scores 5, so the maximum raw score is 50. Divide the raw score by 50 and multiply by 100 to get the percentage. If someone skips a section, divide by 5 times the number of sections they did answer, so a missed section does not silently count as no disability.
What does an ODI score of 45 percent mean?
It falls in the severe band, 41 to 60. In practice that describes someone whose pain is the main problem in daily life, where travel, social life, and personal care all need careful management. The band is a description of current function, not a prognosis, and the same person can move between bands within weeks.
How much does an ODI score have to change to matter?
An international consensus on low back pain outcomes proposed 10 points as the minimal important change, or alternatively a 30 percent change from baseline. In lumbar spine surgery specifically, a study of 454 patients at one year put the minimum clinically important difference at 12.8 points. Which threshold applies depends on the population and the intervention.
How long does the ODI take?
Between three and a half and five minutes to complete, and about a minute to score. It is short enough to repeat at every visit, which is why it became the standard outcome measure in lumbar spine trials.
Is the ODI free?
Yes. It is free to take here. No training or certification is needed to give it.
Which version of the ODI should be used?
Version 2.0 is the standard one. Fairbank and Pynsent counted four English versions in 2000 and warned that some published copies contain misprints and that many omit the scoring system, so a form found loose on the internet may not score the way the literature assumes. Variants differ in their sections too. The AAOS and MODEMS version drops the sex life and lifting sections and scores the remaining eight differently, so its numbers are not interchangeable with the standard form.
Does the ODI diagnose a back problem?
No. It measures how much back pain is limiting daily life and produces reference information for you and your clinician. It says nothing about the cause.
Evidence, psychometrics and provenance
Developed by Jeremy Fairbank and colleagues at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry and first published in 1980. Fairbank and Pynsent reviewed it in Spine in 2000 and found at least 114 studies had supplied validation data by then.
Psychometrics
Test-retest reliability has been reported in many separate cohorts, using different versions of the form, and those intraclass correlations do not converge on a single value, so none is quoted here as the figure for the instrument. What the literature does agree on is how much change counts, which is what the rows below record.
- Minimal important change
- 10 points, from an international consensus on low back pain outcomes (Ostelo et al., 2008)
- Change after lumbar spine surgery
- 12.8 points in 454 patients at one year (Copay et al., 2008)
- Alternative threshold
- A 30 percent change from baseline, which the same consensus proposed for all the measures it covered
- Evidence base
- At least 114 published studies had supplied validation data by 2000 (Fairbank and Pynsent)
- Version caution
- Four English versions exist. Some published copies carry misprints and many omit the scoring system (Fairbank and Pynsent, 2000).
References
- 1.Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-2952.
- 2.Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008;33(1):90-94.
- 3.Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. 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. Spine J. 2008;8(6):968-974.
This assessment uses a validated instrument and is reference information, not a diagnosis.