What Is the Oswestry Disability Index?

The Oswestry Disability Index, also called the Oswestry Low Back Pain Disability Questionnaire, is used to assess how a patient's low back pain impacts their ability to do everyday tasks and activities. The Oswestry Disability Index includes questions regarding symptoms and severity of low back pain and the extent that these symptoms interfere with regular activities.

Read on to learn about the Oswestry Disability Index, what it's used for, and how it works.

What It Is

The Oswestry Disability Index is used to determine the severity of a patient’s low back pain and the extent to which it limits their daily activities. The Oswestry Disability Index can help provide objective data about a patient’s low back pain and is a validated measure backed by research that can be used to justify the need for medical treatment.

Low back pain can result from a variety of different causes, including:

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

How It Works

The Oswestry Disability Index is a questionnaire consisting of 10 questions about the impact of low back pain on daily life. The 10 questions consist of the following categories:

• Pain intensity: How intense the pain is and the extent to which pain killers provide symptom relief if used
• Personal care: Whether a patient can perform personal care activities like bathing and dressing with significant pain or limitations, and whether physical assistance from another person is needed
• Lifting: Whether a patient can lift weights with or without pain, whether the weights are light, moderate, or heavy, and whether lifting can be performed from the floor or a higher surface like a table
• Walking: If and to what extent pain limits a patient’s walking distance and independence, or if an assistive device like a cane or crutches is needed
• Sitting: If and to what extent pain limits a patient’s sitting tolerance
• Standing: If and to what extent pain limits a patient’s standing tolerance
• Sleeping: If and to what extent pain limits a patient’s sleeping duration, and whether pain medication is needed to help a patient sleep comfortably
• Social life: If and to what extent a patient’s social activities are limited due to pain
• Traveling: If and to what extent pain limits a patient’s ability to travel
• Employment or homemaking duties: Whether pain limits a patient’s ability to perform job-related and/or homemaking activities, including physically demanding and light duties

Patients self-report the information and complete it on their own based on their understanding of the extent of their low back pain and disability.

Each question can be scored between 0 and 5, in which 0 corresponds to no limitations at all and 5 corresponds to complete disability. The scores from all 10 questions are added together for a cumulative total score out of 50 points. 

Uses

The Oswestry Disability Index assesses the extent to which a patient’s low back pain limits daily activities, which can be useful in clinical documentation for medical services. 

Unlike other outcome measures in which a higher score is typically a better score, a higher score on the Oswestry Disability Index 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

In order to develop a treatment plan and receive authorization from insurance companies, physical therapists must create individualized goals for each patient. One of the most important aspects of a physical therapy goal is the fact that it must be measurable. 

In addition to monitoring range of motion (how far you can extend a joint) and strength testing, the Oswestry Disability Index provides a numerical score to track functional limitations. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits, with a new score used as a goal for treatment.

According to a 2013 study, the minimal clinically important difference (MCID) for the Oswestry Disability Index is 12.88. The MCID is the minimum score needed for healthcare providers to confirm the progress in function that treatment is having on a patient.

Along with results from a physical examination performed by a physical therapist, the patient’s score on the Oswestry Disability Index and severity of symptoms can help healthcare providers determine an appropriate treatment plan.

• No disability: No treatment is indicated other than advice for lifting mechanics and general physical activity to stay healthy.
• Mild disability: Conservative measures like physical therapy, exercise, hot or cold therapy, pain medication, and rest are needed to help alleviate symptoms.
• Moderate disability: More involved intervention is needed, which can include extensive physical therapy services and pain management.
• Severe disability: Significant medical intervention is needed, which may include surgery, pain management, adaptive equipment like wheelchairs, and help from a caretaker.
• Completely disabled: Patients are either bedbound or are exaggerating their symptoms. For bedbound patients, a caretaker is needed to complete daily activities and self care tasks.

A Word From Verywell

The Oswestry Disability Index is a useful way to gauge how low back pain may affect a patient's daily activities. It is important for physical therapists to incorporate this outcome measure into a patient's treatment plan.

Along with other changes, such as improvements in range of motion, strength, and quality of movement, a decrease in total score on the Oswestry Disability Index can help show the positive impact treatment is having in managing low back pain. Keep in mind that because patients self-report this outcome measure, it has its limitations and may not always accurately reflect a patient's disability.