Using the Oswestry Disability Index to Evaluate Lower Back Pain

Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals’ ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan?

Oswestry Disability Questionnaire

The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual’s lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020)

• Poor posture
• Pregnancy
• Low back muscle strain
• Muscle imbalances
• Bulging discs
• Herniated discs
• Nerve root compression
• Sacroiliac joint dysfunction
• Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
• Lumbar vertebrae compression fractures – usually from trauma or osteoporosis.
• Low back surgery – including spinal fusions, discectomies, and laminectomies.
• Spinal stenosis
• Spondylolisthesis
• Scoliosis

How The Questionnaire Works

The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.)

Pain Intensity

• How intense is the pain?
• If painkillers are used, how much symptom relief do they provide?

Personal Care

• Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
• Whether physical assistance from another person is needed?

Lifting

• Can the patient lift objects like weights with or without pain?
• Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?

Walking

• If and to what extent does the pain limit the patient’s walking distance and independence?
• If an assistive device like a cane or crutches are needed?

Sitting

• If so, how much pain limits the patient’s sitting tolerance?

Standing

• If so, how much pain limits the patient’s standing tolerance?

Sleeping

• If so, how much pain limits a patient’s sleeping duration?
• Whether pain medication is needed to help the patient sleep comfortably?

Social Life

• If and to what extent a patient’s social activities are limited because of pain symptoms?

Traveling

• If so, to what extent does pain limit a patient’s ability to travel?

Employment and/or Homemaking Duties

• Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?

1. Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
2. Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
3. The scores from all the questions are added together for a cumulative total score of 50 points.

Scores

The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria:

• 0–4: No disability
• 5–14: Mild disability
• 15–24: Moderate disability
• 25–34: Severe disability
• 35–50: Completely disabled

Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient’s progress in function due to treatment. (Johnsen, L. G. et al., 2013)

By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan.

No Disability

• Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.

Mild Disability

• Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.

Moderate Disability

• More aggressive intervention is needed, which can include extensive physical therapy services and pain management.

Severe Disability

• Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.

Completely Disabled

• Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.

Injury Medical Chiropractic and Functional Medicine Clinic

Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment’s positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Optimizing Your Wellness

References

National Institute of Neurological Disorders and Stroke. (2020). Low Back Pain Fact Sheet. Retrieved from www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

American Academy of Orthopedic Surgeons. (N.D.). Oswestry Low Back Pain Disability Questionnaire. www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf

Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. doi.org/10.1186/1471-2474-14-148