Oswestry Disability Index (ODI)

Pain and function evaluation in patients with low back disability

The Oswestry Disability Index (ODI) is a 10-item measure for low back pain evaluation. It is one of the most common validated instruments for low back pain measurement and has also been used for patients with spinal deformities, with symptomatic degenerative disc disease and with degenerative lumbar spinal stenosis.

The items of the questionnaire assess pain as well as deficits in physical and social functioning and activities of daily living.

In comparison with the Roland–Morris disability questionnaire (RMDQ), another low back pain tool, the ODI may be a better measure for patients with severe and persistent symptoms, whereas the RMQ has advantages for assessing patients with mild to moderate disability 1.


The questionnaire was developed to evaluate the impact of patients’ low back pain and function on everyday life. The tool has been used to assess a wide range of back issues, such as patients with symptomatic degenerative disc disease 2, lumbar spinal stenosis 3 4, spinal stenosis caused by metastatic masses 5, spinal deformities (adults) 6 and neuropathy after failed back surgery 7.

Items - Dimensions - Completion time

Ten items have to be answered by selecting 1 of 6 response options per item. The scope includes physical parameters (lifting, walking, sitting, standing and sleeping), pain, functioning in everyday life (personal care, sex life and travel) and aspects of social functioning. 8 Various papers have shown that it takes 5 minutes to complete the questionnaire on average. 9 10

Scoring method

The responses concerning each item are given a score of 0 to 5. All 10 items are scored in this manner. After all items have been completed, the final score is calculated as follows:

(sum of all scored points / highest possible total score) × 100%

Example: (16 points scored / 50) x 100% = 32%

If an item is skipped or not applicable, the highest possible total score will be 45 instead of 50. The final score is always a percentage to allow for skipped or nonapplicable items.

Score interpretation

The lower the score, the better the patient’s state of back health.

0% to 20%: minimal disability: The patient can cope with most activities of daily living. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.

21%–40%: moderate disability: The patient experiences pain and difficulty with sitting, lifting and standing. Travel and social life are difficult, and he or she may be disabled with regard to employment. Personal care, sexual activity and sleeping are not grossly affected. The patient can usually be managed by conservative means.

41%–60%: severe disability: Pain is the main problem in this patient, and activities of daily living are affected. This patient requires detailed examination.

61%–80%: crippled: Back pain impinges on all aspects of the patient’s life. Positive intervention is required.

81%–100%: The patient is either bedridden or exaggerating his or her symptoms.

The ODI has been validated in various languages 11 12 13 14 15. There are different versions in use. Version 2.1b is the most current English version and is recommended for use by the distributor. Translations of version 2.1a are available and will soon become available for version 2.1b.

MAPI Research Trust (Lyon, France) 16 17

For students, physicians, nonfunded academic users and routine clinical use, the questionnaire can be accessed directly and translations are available at no cost.

For funded academic users, healthcare organizations, commercial users, and IT companies, fees may apply and a licensing agreement must be entered into. 18

The ODI is quick to complete, and the score interpretation is intuitive and easy. In addition, the tool has wide international acceptance and is one of the most frequently used low back pain questionnaires. It tends to score higher in comparison with the RMQ, which leads to the conclusion that the ODI is a better measure of more severe disability. 1
The ODI is not as good a measure of mild or moderate disability as it is of severe disability. It has been shown that many patients skip item 8, which deals with sex life 19. Moreover, the ODI does not evaluate mental health.

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  1. Roland, Martin, and Jeremy Fairbank. “The Roland–Morris disability questionnaire and the Oswestry disability questionnaire.” Spine 25.24 (2000): 3115-3124.
  2. Siepe, Christoph J., et al. “Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation.” European Spine Journal 21.11 (2012): 2287-2299.
  3. Weinstein, James N., et al. “Surgical versus nonsurgical therapy for lumbar spinal stenosis.” New England Journal of Medicine 358.8 (2008): 794-810.
  4. Sirvanci, Mustafa, et al. “Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.” European spine journal 17.5 (2008): 679-685.
  5. Fehlings, Michael G., et al. “Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study.” Journal of Clinical Oncology 34.3 (2016): 268-276.
  6. Schwab, Frank J., et al. “Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.” Spine 38.13 (2013): E803-E812.
  7. Kumar, Krishna, et al. “Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome.” Pain 132.1-2 (2007): 179-188.
  8. Fairbank, Jeremy CT, and Paul B. Pynsent. “The Oswestry disability index.” Spine 25.22 (2000): 2940-2953.
  9. Vianin, Michael. “Psychometric properties and clinical usefulness of the Oswestry Disability Index.” Journal of chiropractic medicine 7.4 (2008): 161-163.
  10. Davidson, Megan, and Jennifer Keating. “Oswestry disability questionnaire (ODQ).” Aust J Physiother 51.4 (2005): 270.
  11. Monticone, Marco, et al. “Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study.” Spine 34.19 (2009): 2090-2095.
  12. van Hooff, Miranda L., et al. “The Oswestry Disability Index (version 2.1 a): validation of a Dutch language version.” Spine 40.2 (2015): E83-E90.
  13. Denis, Isabelle, and Luc Fortin. “Development of a French-Canadian version of the Oswestry Disability Index: cross-cultural adaptation and validation.” Spine 37.7 (2012): E439-E444.
  14. Chow, Jonathan HW, and Chetwyn CH Chan. “Validation of the Chinese version of the Oswestry Disability Index.” Work 25.4 (2005): 307-314.
  15. Mannion, A. F., et al. “Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity.” European spine journal 15.1 (2006): 55-65.
  16. https://mapi-trust.org/pro_newsletter/the-oswestry-disability-index/
  17. https://mapi-trust.org/questionnaires/odi/
  18. https://eprovide.mapi-trust.org/instruments/oswestry-disability-index
  19. Roland, Martin, and Jeremy Fairbank. “The Roland–Morris disability questionnaire and the Oswestry disability questionnaire.” Spine 25.24 (2000): 3115-3124.
  20. Denteneer, Lenie, et al. “The modified low back pain disability questionnaire: reliability, validity, and responsiveness of a Dutch language version.” Spine 43.5 (2018): E292-E298.