Oswestry Disability Index - formazionesostenibile.it

FIRE STATION # 37 June 7, 2005STATE ROAD 54, PASCO COUNTY, FLORIDAINDEX TO SPECIFICATIONSSectionNo. OfNumber PagesDIVISION 0 -BIDDING AND CONTRACT REQUIREMENTSPrepared by Pasco County PurchasingDIVISION 1 - GENERAL REQUIREMENTS01010 Summary of Work 101300 Submittals 501410 Testing Laboratory Services 1601500 Construction Facilities/Temperature Controls 601600 Material and Equipment 301700 Contract Closeout 5DIVISION 2 - SITE WORK02010 Subsurface Investigation 202100 Site Preparation 402220 Excavating, Filling and Grading 902270 Erosion, Sedimentation and Dust Control 102281 Termite Control 402500 Asphalt Paving and Surfacing 502528 Concrete Walks and Curbs 202701 Site Utilities 202900 Landscape Work 7DIVISION 3 - CONCRETE WORK03100 Concrete Formwork 403210 Concrete Reinforcing 403250 Concrete Accessories 203300 Cast-In-Place Concrete 1403370 Concrete Curing 2DIVISION 4 - MASONRY04090 Masonry Accessories 604100 Mortar and Masonry Grout 404210 Clay Masonry Units 4i

ODIOSWESTRY DISABILITY INDEXFairbank J, Couper J, Davies J, O'Brien J.The Oswestry low back pain questionnaire.Physiotherapy 1980;66:271-73.Jeremy FairbankProfessor of Spine SurgeryOxford, UK

ODI version 2.1aSection 1 - Pain intensitySection 2 - Personal care (washing, dressing, etc.)Section 3 - LiftingSection 4 - WalkingSection 5 - SittingSection 6 - StandingSection 7 - SleepingSection 8 - Sex life (if applicable)Section 9 - Social lifeSection 10 - Travelling

Section 1 - Pain intensity I have no pain at the moment. The pain is very mild at the moment. The pain is moderate at the moment. The pain is fairly severe at the moment. The pain is very severe at the moment. The pain is the worst imaginable at the moment.

Section 2 - Personal care(washing, dressing, etc.) I can look after myself normally without causing extrapain. I can look after myself normally but it is very painful. It is painful to look after myself and I am slow andcareful. I need some help but manage most of my personalcare. I need help every day in most aspects of self care. I do not get dressed, wash with difficulty and stay inbed.

Section 3 - Lifting I can lift heavy weights without extra pain. I can lift heavy weights but it gives extra pain. Pain prevents me from lifting heavy weights off the floor butI can manage if they are conveniently positioned, e.g. on atable. Pain prevents me from lifting heavy weights but I canmanage light to medium weights if they are convenientlypositioned. I can lift only very light weights. I cannot lift or carry anything at all.

Section 4 - Walking Pain does not prevent me walking any distance. Pain prevents me walking more than one mile (1 Kilometre). Pain prevents me walking more than a quarter of a mile (500metres). Pain prevents me walking more than 100 yards (100 metres). I can only walk using a stick or crutches. I am in bed most of the time and have to crawl to the toilet.

Section 5 - Sitting I can sit in any chair as long as I like. I can sit in my favourite chair as long as I like. Pain prevents me from sitting for more than 1 hour. Pain prevents me from sitting for more than half anhour. Pain prevents me from sitting for more than 10minutes. Pain prevents me from sitting at all.

Section 6 - Standing I can stand as long as I want without extra pain. I can stand as long as I want but it gives me extra pain. Pain prevents me from standing for more than 1 hour. Pain prevents me from standing for more than half an hour. Pain prevents me from standing for more than 10 minutes. Pain prevents me from standing at all.

Section 7 - Sleeping My sleep is never disturbed by pain. My sleep is occasionally disturbed by pain. Because of pain I have less than 6 hours sleep. Because of pain I have less than 4 hours sleep. Because of pain I have less than 2 hours sleep. Pain prevents me from sleeping at all.

Section 8 - Sex life (if applicable) My sex life is normal and causes no extra pain. My sex life is normal but causes some extrapain. My sex life is nearly normal but is very painful. My sex life is severely restricted by pain. My sex life is nearly absent because of pain. Pain prevents any sex life at all.

Section 9 - Social life My social life is normal and causes me no extra pain. My social life is normal but increases the degree of pain. Pain has no significant effect on my social life apart fromlimiting my more energetic interests, e.g. sport, etc. Pain has restricted my social life and I do not go out as often. Pain has restricted social life to my home. I have no social life because of pain.

Section 10 - Travelling I can travel anywhere without pain. I can travel anywhere but it gives extra pain. Pain is bad but I manage journeys over two hours. Pain restricts me to journeys of less than one hour. Pain restricts me to short necessary journeys under30 minutes. Pain prevents me from travelling except to receivetreatment

0% = no disability - “normal”100% = total disability

ODI as a baseline assessment

In 1980 we suggested…0-20% Minimal Disability20-40% Moderate Disability40-60% Severe Disability60-80% Crippled80-100% Exaggerating or Bedbound

In 2000 we reviewed >300 citationsFairbank J, Pynsent P. The Oswestry Disability Index. Spine 2000;25:2940-53

ODI as a measure of change

2 year f/u data from MRC Spine Stabilisation Trial 2005

Some competitors…• Core Outcome Measures Index (COMI)• Roland Morris Disability Questionnaire

Core Outcome Measures Index• Standardized set of outcome measures for use inpatients with back pain was proposed by amultinational group of experts• Deyo RA, Battie M, Beurskens AJHM, BombardierC, Croft P, Koes B, Malmivaara A, Roland M, KorffM, Waddell G. Outcome measures for low backpain research: a proposal for standardized use.Spine. 1998;23:2003–2013.doi: 10.1097/00007632-199809150-00018

Core Outcome Measures IndexUsed in SPINE Tango• The COMI has one question each on– back (neck) pain intensity,– leg/buttock (arm/shoulder) pain intensity,– Function– symptom-specific well being– general quality of life– work disability– social disability• scored as a 0–10 index

COMI

COMI• Standard outcome for Spine Tango• Needs to be completed in full

Roland Morris Disability Questionnairehttp://www.rmdq.org/• Roland MO, Morris RW. A study of the naturalhistory of back pain. Part 1: Development of areliable and sensitive measure of disability in lowback pain. Spine 1983; 8: 141-144.• Selected questions from Pain Disability Index• Does this apply to you now? yes– Score 0-24– Only scores marked questions ?missing data– Widely used– Advocated for primary care settings

ODI vs RMDQ

Scatter plot of simultaneousOswestry Disability Index vs Roland-Morris Index scoresIn a group of 100 back pain patients (via computer interview)Oswestry Disability Index

Scatter plot of simultaneousOswestry Disability Index vs Roland-Morris Index scoresIn a group of 100 back pain patients (via computer interview)Oswestry Disability Index

Scatter plot of simultaneousOswestry Disability Index vs Roland-Morris Index scoresIn a group of 100 back pain patients (via computer interview)Ceiling effect!Oswestry Disability Index

Is RMQ better than ODI for lowdisability studies in primary care?Frost H, Lamb S, Stewart Brown S.Responsiveness of a patient specific outcomemeasure compared with the Oswestry DisabilityIndex V2.1 and the Roland and Morris DisabilityQuestionnaire for patients with sub-acute andchronic low back pain.Spine. 2008;33(22):2450-7.

Responsiveness of a Patient Specific Outcome MeasureCompared With the Oswestry Disability Index v2.1 andRoland and Morris Disability Questionnaire forPatients With Subacute and Chronic Low Back Pain

Surgical treatment of back pain –Baseline ODI scores

Surgical treatment of back pain55%40%

Surgical treatment of back pain?55%40%

Chiro ODI…..Zigler, J; Delamarter, R; Spivak, J; Linovitz, RJ;Danielson, GO; Haider, TT; Cammisa, F; Zuchermann, J;Balderston, R; Kitchel, S; Foley, K; Watkins, R; Bradford,D; Yue, J; Yuan, H; Herkowitz, H; Geiger, D; Bendo, J;Peppers, T; Sachs, B; Girardi, F; Kropf, M; Goldstein, J.Results of the Prospective, Randomized, MulticenterFood and Drug Administration Investigational DeviceExemption Study of the ProDisc(R)-L Total DiscReplacement Versus Circumferential Fusion for theTreatment of 1-Level Degenerative Disc Disease.Spine 2007;32(11):1155-1162

Translations!!!

~44 translations of variable validityPlanned MAPI translations• Arabic for Kuwait• Czech• English for Australia• English for Singapore• English for Canada• Dutch for Belgium• Dutch for the Netherlands• German for Austria• German for Switzerland• Hebrew• Korean for South Korea• Mandarin Chinese for Singapore• Polish• Portuguese for Portugal• Slovak

Please do not use Rogue ODI’s• Chiropractic• “modified” etc etc• Poor translations

What is Normal???• Using ODI to establish normality…

“Normal” ODI scores collected by Fairbank & Pynsent(The Oswestry Disability Index. Spine (Phila Pa 1976.) 2000; 25(22): 2940-2952)• Mayo NE. Letter. Spine. 1995;20:1535–6.• Hupli M, Hurri H, Luoto S, et al. Isokinetic performance capacity of trunk muscles:1. the effect of repetition on measurement of isokinetic performance capacity oftrunk-muscles among healthy controls and two different groups of low-back painpatients. Scand J Rehabil Med 1996;28:201–6.• Hupli M, Heinonen R, Vanharanta H. Height changes among chronic low back painpatients during intense physical exercise. Scand J Med Sci Sports 1997;7:32–7.• Hupli M, Sainio P, Hurri H, et al. Comparison of trunk strength measurementsbetween two different isokinetic devices used at clinical settings. J Spinal Disord1997;10:391–7.• Kankaanpaa M, Taimela S, Webber CL, et al. Lumbar paraspinal muscle fatigabilityin repetitive isoinertial loading: EMG spectral indices, Borg scale and endurancetime. Eur J Appl Physiol Occup Physiol 1997;76:236–42.• Kankaanpaa M, Taimela S, Laaksonen D, et al. Back and hip extensor fatigability inchronic low back pain patients and controls. Arch Phys Med Rehabil 1998;79:412–7.

‘Normal’ healthy populations (n=461) havean ODI mean score of 10 (SD 2-12)• “Successful Treatment” was defined as havingat one year follow-up

Functional status as measured with the ODI (0-100) inthe RealHealthNL study sample (n=524).

What is success?An alternative analysis• Current method:– Achievement of a given change-score, e.g. a 15-point reduction on a 0-100-scaled instrument• BUT achievement of such a change• 1) depends on the initial preoperative score• 2) does not indicate whether a satisfactory symptom state is ultimatelyreached• Material– 532 patients undergoing lumbar spine surgery in Oxford– ODI and the Core Measures Outcome Index (COMI) at various times upto 4y after surgery• “if you had to spend the rest of your life with the symptoms youhave right now, how would feel about it?”– 5-point Likert scale from “very satisfied” to “very dissatisfied”.

What is Normal???

Receiver Operating Characteristics (ROC)• Two analyses were used to derive cut-offscores for ODI that best predicted being 1)“satisfied” and 2) “very satisfied” with thesymptom state.Numbersof Patients“≥satisfied” 114/532(21%)“very 43/532satisfied” (8%)ROC areaunder thecurve95% CI ODIscorecutoffSensitivitySpecificity0.89 0.86-0.92 ≤ 29 88%75%0.94 0.92-0.96 ≤ 14 86%89%

In 1980 we suggested…0-20% Minimal Disability20-40% Moderate Disability40-60% Severe Disability60-80% Crippled80-100% Exaggerating or Bedbound

http://www.mapi-trust.org/• Copyright holders have licensed MAPI to care for ODI• No cost to clinical users, but do need to sign agreement• Some costs for publication and for commercial users.• Check MAPI Trust website for correct versions andtranslations• Currently there are >44 translations, but few of thesehave been approved by MAPI yet• MAPI PROinformation@mapi-trust.org• Use version ODI v2.1a• Other websites/translations– Are considered to be in breach of copyright