The ODI, short for Oswestry Disability Index, measures how low back pain affects ten areas of daily life. The score runs from 0 to 100, a high score signalling high disability. The interpreter is right below.
The international consensus proposes 10 points of minimal important change, while the smallest detectable change measured in older adults is 19.1 points. The two do not say the same thing: the detail is below.
Figures taken from the studies listed at the end of this page, every value carrying its source where it is written. No section of the questionnaire is reproduced: the ODI is licensed.
What the ODI measures
The ODI does not measure pain. It measures what low back pain prevents, across ten areas of ordinary life: washing, dressing, lifting, walking, sitting, sleeping, travelling, social life and sex life. It is a disability questionnaire, which is why a patient in a great deal of pain can score modestly on it.
It was born in 1980 in Oswestry, in a British physiotherapy journal. Its original publication describes the questionnaire; it carries no psychometric value, and citing it for a reliability coefficient is an attribution error one sees regularly.
The score runs from 0 to 100 in the direction of disability: the higher it is, the more impaired the patient. As with the DASH, that is the opposite of functional scales where high is good.
Which ODI, exactly
The question is not rhetorical. The twenty-year review, written by the authors themselves, catalogues four English versions and nine in other languages, backed by at least 114 usable studies. There is therefore no single ODI but a family, and the versions are not interchangeable.
On the French side, the reference validated adaptation is French-Canadian, derived from version 2.0. In 72 chronic low back pain patients it gives an internal consistency of 0.88, a 48-hour test-retest reliability of ICC 0.92 (95% CI 0.87 to 0.95) and a correlation of 0.90 with the Quebec disability scale.
The practical consequence is the same as for every multi-version scale: the version goes in the notes next to the score, from the first administration.
Ten points or nineteen
Two numbers circulate for saying a patient has changed, and they do not measure the same thing.
The first is an international consensus from 2008, proposing 10 points of minimal important change for the ODI scored 0 to 100. It is the most quoted figure, and it comes from a consensus process, not from a single measurement.
The second is a measurement. In 214 low back pain patients with a mean age of 66.2, 193 of them seen again at two weeks, the smallest detectable change of the ODI reaches 19.1 points. In other words, in that population, the consensus threshold is barely more than half the measurement error of the instrument.
The point is not to pick one over the other, but to know which one you are invoking. A gain of 12 points reaches the consensus threshold and stays within the measurement noise of older adults: that is an uncertain zone, and naming it is better than hiding it.
| What is measured | Value | Population and sample |
|---|---|---|
| Minimal important change, consensus | 10 points | international consensus, low back pain |
| Smallest detectable change | 19.1 points | 214 patients, mean age 66.2 |
| Test-retest reliability, French version | ICC 0.92 | 72 chronic patients, 48 h |
| Test-retest reliability, older adults | ICC 0.89 | 214 patients, 2 weeks |
| Internal consistency | 0.86 to 0.88 | depending on version and population |
| Versions catalogued | 4 + 9 | English and other languages, 20-year review |
What the score does not tell you
It does not say which area improved. Ten sections summarised into one number means a patient sleeping better but still lifting as poorly can show the same score as a patient in the opposite situation.
Nor does it say whether the disability is severe. The severity categories seen in circulation appear in none of the sources retained here, and asserting them would lend them a validation we have not verified.
Finally, the comparison with the Roland-Morris is unsettled. A systematic review conducted to COSMIN methodology, restricted to head-to-head studies, retains 9 articles and 11 studies, all of poor or fair methodological quality, and concludes that the evidence on the responsiveness of the two questionnaires is contradictory. Preferring one over the other is departmental habit, not evidence.
Why this page does not display the questionnaire
The ODI is licensed by the Mapi Research Trust, an organisation that manages its distribution in order to preserve a standard version in English and in its validated translations. The instrument is therefore not free of rights, and the precise question of online distribution rights is not settled by a verified source. Neither the ten sections nor their response statements are reproduced here: the questionnaire is obtained from the licence holder.
Three administration pitfalls
Not recording the version
Four English versions and nine translations are in circulation. A score of 34 only compares with a score obtained on the same version, and that information vanishes from the notes if it is not written there from the start.
Reading the score backwards
Zero means no disability, one hundred means maximal disability. A patient going from 52 to 28 is markedly better, and the habit of scales where high is good regularly drives the opposite conclusion.
Announcing a 10-point improvement without saying in whom
The consensus threshold applies to low back pain in general. In older adults it sits well below the measured smallest detectable change. The same gap therefore does not carry the same weight depending on the patient in front of you.
Frequently asked questions
What does ODI stand for?
ODI stands for Oswestry Disability Index. It was published in 1980 by Fairbank, Couper, Davies and O'Brien, under the original title of low back pain disability questionnaire.
How is the ODI scored?
The final score runs from 0 to 100, a high score signalling high disability. The ten sections and their response statements belong to the licence holder and are not reproduced here.
How much change counts?
The international consensus proposes 10 points. But the smallest detectable change measured in older low back pain patients reaches 19.1 points: between the two, the gap exists without it being possible to assert that it exceeds measurement error.
Is there a validated French version?
Yes, a French-Canadian adaptation derived from version 2.0, validated in 72 chronic low back pain patients, with a 48-hour test-retest reliability of ICC 0.92.
Is the ODI free to use?
No. The instrument is licensed by the Mapi Research Trust, which aims to preserve a standard version in English and in its validated translations. Since the precise question of online distribution rights is not settled by a verified source, this page reproduces no section.
References
6 sources, PMIDs included
- Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66(8):271-3. PMID 6450426. The original publication, ancestor of every current version. The indexed abstract carries no psychometric value: citing it for a reliability figure would be an attribution error.
- Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25(22):2940-52. PMID 11074683. The twenty-year review by the authors themselves: 4 English versions and 9 in other languages, at least 114 usable studies, more than 200 citations. It is what establishes that there is no single ODI.
- 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 2008;33(1):90-4. PMID 18165753. The international consensus proposing 10 points of minimal important change for the ODI scored 0 to 100, against 5 points for the Roland-Morris and 20 for the Quebec questionnaire.
- Denis I, Fortin L. Development of a French-Canadian version of the Oswestry Disability Index: cross-cultural adaptation and validation. Spine (Phila Pa 1976) 2012;37(7):E439-44. PMID 22037523. The validated French adaptation, in 72 chronic low back pain patients: internal consistency 0.88, 48-hour test-retest reliability ICC 0.92 (95% CI 0.87 to 0.95), correlation 0.90 with the Quebec scale.
- Chiarotto A, Maxwell LJ, Terwee CB, Wells GA, Tugwell P, Ostelo RW. Roland-Morris Disability Questionnaire and Oswestry Disability Index: which has better measurement properties? A systematic review and meta-analysis. PMID 27081203. A COSMIN systematic review restricted to head-to-head comparisons: 9 articles, 11 studies, all of poor or fair methodological quality, and contradictory evidence on the responsiveness of both instruments.
- Jenks A, Hoekstra T, van Tulder M, Ostelo RW, Rubinstein SM, Chiarotto A. Roland-Morris Disability Questionnaire, Oswestry Disability Index and Quebec Back Pain Disability Scale: which has better measurement properties in older adults with low back pain? PMID 35584027. 214 patients with a mean age of 66.2, 193 seen again at two weeks. Internal consistency 0.86, reliability ICC(2,1) 0.89, and above all a smallest detectable change of 19.1 points.
Page written by Anthony Baillon, physiotherapist, co-founder of Physio Learning. The questionnaire itself is by Fairbank et al., 1980, and it is now licensed by the Mapi Research Trust: this page documents and interprets it, it reproduces none of its sections.