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      The Oswestry Disability Index :

      ,

      Spine

      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          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 databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

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          Most cited references 129

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          Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis.

          A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.
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            Responsiveness of functional status in low back pain: a comparison of different instruments.

            This study compares the responsiveness of three instruments of functional status: two disease-specific questionnaires (Oswestry and Roland Disability Questionnaires), and a patient-specific method (severity of the main complaint). We compared changes over time of functional status instruments with pain rated on a visual analog scale. Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used: effect size statistics and receiver-operating characteristic method. We chose global perceived effect as external criterion. A cohort of 81 patients with non-specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment. According to the external criterion 38 patients improved. The results of both strategies were the same. All instruments were able to discriminate between improvement and non-improvement. The effect size statistics of the instruments were higher in the improved group than in the non-improved group. For each instrument the receiver-operating characteristic curves showed some discriminative ability. The curves for the Roland Questionnaire and pain were closer to the upper left than the curves for the other instruments. The sensitivity to change of the rating of Oswestry Questionnaire was lower than that of the other instruments. The main complaint was not very specific to change. The two strategies for evaluating the responsiveness were very useful and appeared to complement each other.
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              Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach.

              To examine the relation between responsiveness coefficients derived directly from a calculation of average change resulting from a treatment intervention (Responsiveness-Treatment or RT) and those derived from retrospective analysis of changed and unchanged groups (Responsiveness Retrospective or RR) based on a global measure of change. Two approaches were used. First, we used simulation methods to examine the analytical relationship between the RT and RR coefficients. We then located eight studies where it was possible to compute both RT and RR coefficients. As anticipated from theoretical arguments, the RR coefficients were larger than the RT coefficients (1.50 versus 0.41, p < .0001). Within study there was no predictable relationship between the two indices. Across studies, the magnitude of the RR coefficient was strongly related to the correlation with the retrospective global scale, and unrelated to the magnitude of the RT coefficient. The simulated curves fit well with the observed data, and substantiated the observation that the relation between RT and RR coefficients is complex and only weakly related to the size of the treatment effect. Retrospective methods of computing responsiveness yield little information about the ability of an instrument to detect treatment effects, and should not be used as a basis for choice of an instrument for applications to clinical trials.
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                Author and article information

                Journal
                Spine
                Spine
                Ovid Technologies (Wolters Kluwer Health)
                0362-2436
                2000
                November 2000
                : 25
                : 22
                : 2940-2953
                Article
                10.1097/00007632-200011150-00017
                11074683
                © 2000
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