The Roland-Morris Disability Questionnaire and the ...



The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire

Martin Roland

National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 6PL, United Kingdom. Tel +44 161 275 7659. Fax +44 161 275 7600. m.roland@man.ac.uk

Jeremy Fairbank

Nuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom

Tel. +44 1865 741155. Fax +44 1865 744455. Jeremy.fairbank@ndos.ox.ac.uk

Introduction

Condition specific health status measures are commonly used as outcome measures in clinical trials, and to assess patient progress in routine clinical practice. The expert panel which met to discuss the special issue of Spine recommended that, where possible, a condition specific measure for back pain should be chosen from two widely used measures, the Roland-Morris Disability Questionnaire106 (RDQ) or the Oswestry Disability Index (ODI)30. These two measures have been used in a wide variety of situations over many years, and each is available in a number of languages.

This paper describes these two instruments along with evidence of their validity and reliability, and some comparative results using the two questionnaires. The instruments themselves are included in the appendices. When used in the forms reproduced in the appendices, no permission is required from the authors or from Spine. Other back pain specific health status measures are described by Kopec elsewhere in this edition of Spine.

The Roland-Morris Disability Questionnaire (RDQ)

Development of the Roland Morris Disability Questionnaire

The Roland-Morris Disability Questionnaire (RDQ) 106 is a health status measure designed to be completed by patients to assess physical disability due to low back pain. It was designed for use in research, e.g. as an outcome measure for clinical trials, but has also been found useful for monitoring patients in clinical practice. It was originally designed for use in primary care in the UK, but has been used in a variety of settings.

The RDQ was derived from the Sickness Impact Profile (SIP) 3, which is a 136 item health status measure covering all aspects of physical and mental function. Twenty four items were selected from the SIP by the original authors because they related specifically to physical functions likely to be affected by low back pain. Each item was qualified with the phrase ‘because of my back pain’ in order to distinguish back pain disability from disability due to other causes – something which patients are in general able to do without difficulty 100

Patients completing the RDQ are asked to tick a statement if it applies to them that day. This approach was chosen to make it suitable for following short term changes in back pain, e.g. the relatively rapid resolution of symptoms of most patients seen in primary care, or short terms changes in response to treatment. The RDQ score is calculated by adding up the number of items checked. Items are not weighted. The scores therefore ranges from 0 (no disability) to 24 (maximum disability). Although designed for paper administration, the RDQ has also been satisfactorily used on computer and by telephone.

The original RDQ also contains a six point pain rating scale in the form of a pain thermometer. However, we now recommend that the pain scale of the SF-36 should be used in preference, as described in the article on pain measurement by von Korff elsewhere in this volume.

The RDQ is short, simple to complete, and readily understood by patients.. Stratford et al (1994)121 found fewer incomplete or ambiguous responses to the RDQ than to the Oswestry questionnaire. These characteristics, along with evidence of its scientific validity, have led to its widespread use: it is now available in twelve languages (see below). The questionnaire is reproduced in Appendix 1. There are no restrictions on its use: it may be used without permission from either the authors or from Spine.

Modifications and translations of the RDQ

Translations of the RDQ are available in French, German, Dutch, Flemish, Romanian, Spanish, Italian, Czech, Swedish, Portuguese and Polish. Available translations may be downloaded from (enter Spine website). The file on this website also contains available details of how the translations were done so that users can judge the likely validity of the translation (reference Beaton’s article on translating instruments in this volume of Spine). These translations of the RDQ may also be used without permission from the journal Spine, or permission from the authors. If other translations are made, they may be sent to MR with details of how the translation was done, in order that they can be included on the Spine website.

A number of researchers have proposed modifications to the RDQ. The simplest modification to the wording of the questionnaire has been to change the terminal phrase of each statement from ‘because of my back’ to ‘because of my back or leg problem 98. This makes the questionnaire more suitable for use in a population of patients with sciatica, and is an acceptable modification.

Other authors have proposed modifications to individual items. Stratford and Binkley (1997)118 suggested that a number of items were redundant, and that the questionnaire could be improved by being reduced to 18 items. Patrick et al (1995)98 removed five potentially redundant items, and suggested that responsiveness could be increased by adding four additional items relating to sexual function, daily work, expressions of concern to others, and the need to rub or hold areas that hurt. On the whole these modifications seem to provide only modest improvement on the original version, and an international group of experts 23 suggested use of the original version since it has been widely used in many countries.

Underwood et al (1999)144 suggested a modification which asked, for each item of the RDQ, how many days of the previous month they had been affected. Although this version has not been validated, it attempts to incorporate elements of the amount of time that people are affected by their back pain, which often fluctuates 146 However, it did not perform as well as a modification of von Korff’s own questionnaire 144.

Properties of RDQ scores

In the original sample used for development and validation of the scale, median scores of patients presenting with back pain in primary care were 11 on presentation, 8 one week later, and 4 one month later 105. RDQ scores reported in a wide variety of settings are shown in Table 3. In general RDQ scores have little or no relationship to the age or sex of the respondents.

Face and content validity of the RDQ

The RDQ focuses on a limited range of physical functions which include walking, bending over, sitting, lying, dressing, sleeping, self care and daily activities (see Appendix 1). These were chosen as functions which would be relevant to all patients with back pain. The scoring system does not therefore permit or require a ‘non-applicable’ response. The statements in the RDQ focus almost exclusively on physical function, with only one question on mood. Some aspects of physical function are not explicitly included, for example lifting and twisting or turning.

The limited range of the RDQ is both a strength and weakness in terms of its content validity. The questionnaire covers only a limited range of the problems which a patient with back pain may face, and in particular does not address psychological or social problems. These are undoubtedly of importance, and in situations where their measurement is important, the RDQ should be combined with specific measures of these functions. However, the restricted nature of the domains covered by the RDQ is also a strength in that this makes the scores easy to understand and interpret.

Construct validity of the RDQ

In assessing the construct validity of a health status measure, it is conventional to compare scores of a questionnaire with those of other established measures. As would be expected with a measure of self reported physical disability, RDQ scores correlate well with other measures of physical function, including the physical subscales of SF-36, the Sickness Impact Profile 21,58,98, the Quebec Back Scale 66, and the Oswestry questionnaire 121,79. Relatively high correlations are also found between RDQ scores and pain ratings 6

The RDQ does not attempt to measure psychological distress associated with back pain, and thus correlates less well with measures of psychological disability, for example the psychosocial scales of the Sickness Impact Profile 58. In common with other self reported disability measures, it shows only modest correlation with direct measures of physical function 21,109.

Internal consistency of the RDQ

The RDQ has good psychometric properties as evidenced by internal consistency and responsiveness. Crohnbach’s alpha for the scale has been estimated as 0.93 49 0.90 64, 0.84 57 The same statistic for modified versions of the RDQ include 0.91 118 and 0.90 98. These are high but within the range of 0.7 to 0.9 recommended by Nunnally (1978) 97.

Reproducibility of the RDQ

A number of attempts have been made to assess the reproducibility of the RDQ by testing and re-testing some time after the initial assessment. While generally regarded as an important element of the validity of a questionnaire, the concept of test re-test reliability is somewhat doubtful for an instrument which has been designed to pick up short term changes in a condition which is itself notoriously changeable.

It is therefore not surprising that when the test re-test intervals are short (e.g.), that correlations between two sets of scores are higher than when the test retest interval is long. However, interpretation of these may be difficult if the interval is so short that patients can remember their previous responses. Quoted test-re-test correlations include 0.91 (same day106), 0.88 (1 week, 59), 0.83 (3 weeks21). In patients with chronic back pain, a correlation of 0.72 were reported for scores taken 39 days apart 58.

Responsiveness of the RDQ

A number of methods can be used to assess the responsiveness of health status measures, in order to compare different measures in terms of their ability to detect changes over time.

The RDQ compares well with other commonly used disability scales for back pain 4. It is at least as responsive in patients with back pain as its parent the Sickness Impact Profile or the SIP’s physical subscales 21,58. Data on responsiveness of the RDQ have been published by a number of authors 21,64,98,124,6,120,104,122,119. In a later section, we comment on the responsiveness of the RDQ compared to the Oswestry questionnaire.

Another important element of a questionnaire’s responsiveness is the smallest effect that is clinically significant. 6 suggest that the smallest change likely to be clinically significant lies between 2.5 and 5 points. However, this may vary depending on the level of disability of the patients. Stratford et al (1998)122 suggest that the minimum clinically important change in scores is 1-2 points for patients with little disability, 7-8 points for patients reporting high levels of disability, and 5 points in unselected patients. Patrick et al (1995)98 suggests 2-3 points as the minimum clinically important difference (for a 23 item version of the RDQ). These are minimum changes in score which should be regarded as clinically significant in relation to individual patients. Setting the minimally clinically important difference as high as 5 in designing a clinical trial would risk under-powering the trial, as fewer patients are needed if a trial is designed on the basis of a large change in score. For sample size calculations for clinical trials, we therefore recommend that changes in scores of 2-3 points on the RDQ should be used.

Oswestry Disability Index

Development of the ODI

Development of the Oswestry Disability Index was initiated by John O'Brien in 1976 in a specialist referral clinic seeing large numbers of patients with chronic low back pain. Back pain patients were interviewed by an orthopaedic surgeon (Stephen Eisenstein), an occupational therapist (Judith Couper) and a physiotherapist (Jean Davies) to identify the disturbance of activities of daily living through chronic back pain. It was designed as a measure of both assessment and outcome. Various drafts of the questionnaire were tried. Version 1.0 of the questionnaire was published in 198030 and widely disseminated from the 1981 ISSLS meeting in Paris.

The questionnaire can be completed in less than five minutes and is scored in less than a minute. Scores for the ODI in a wide variety of settings are shown in table 1.

|Category |Total no. |No. of |Weighted mean |S.D. / |F |Sources used |Sources not|

| | |groups |ODI score |range | | |used |

|‘Normal’ populations |461 |4 |10.19 |2.2 - 12 |0.37 |90,52,50,53,62, 61 |20 |

|Pelvic fractures |31 |1 |13.26 |15.4 |- |44 | |

|Idiopathic scoliosis |1264 |5 |13.81 |9.2-13 |0.03 |33,90 | |

|Neck pain |56 |1 |21 |9.7 |- |151 | |

|Spondylolisthesis |120 |5 |26.63 |6.1-16 |1.76 |97,115-117, 128 | |

|Primary back pain |2166 |21 |27 |5.8-23.6 |0.33 |34,93,132,92, |86 |

| | | | | | |52,63,50,53,62,81,11| |

| | | | | | |2,61,82,110,111 | |

|Psychiatric patients |75 |1 |30.8 |21.5 |- |150 | |

|Neurogenic claudication |82 |2 |36.65 |17-18 |0.14 |46-48 |20 |

|Chronic back pain |1530 |25 |43.3 |10-21 |0.02 |113,24,40,42, | |

| | | | | | |80,25-27,41 | |

| | | | | | |102,14,133,73,116,69| |

| | | | | | |,74,117,121,131,135,| |

| | | | | | |11,70,85,139,8,9,128| |

| | | | | | |,129,130,136,140,142| |

| | | | | | |, 71,72,138,137, | |

| | | | | | |12,68,75,141 | |

|PID/Sciatica |663 |9 |44.65 |10.5-30.1 |0.16 |25,26,36,27,35,13,38|73,69, |

| | | | | | |,131 |74,70-72,11|

| | | | | | | |4,127,68,75|

|Fibromyalgia |192 |4 |44.83 |14.2-18.9 |0.07 |133-135,139,136, | |

| | | | | | |140,142,138, 137,141| |

|Metastases |100 |2 |48.04 |18.1-23 |0.04 |99,140 | |

Table 1. Normative data for ODI

ODI data have been pooled for various categories of patients. The weighted mean of the groups is given. The ratio of the variances (F) is not significant in any of the categories suggesting that the assumptions used to pool the data to produce the these weighted mean values are reasonable ones. The sources of data used are tabulated. Other sources of data are given in the final column, but the information in these was not sufficient to use in calculation of the weighted mean values.

Modifications and translations of the ODI

The ODI was validated and improved in a study by an MRC group. This version (2.0) is recommended for general use 91,1,100,92. It has been widely distributed by correspondence and is available as part of a computer interview in the UK (slightly modified) 1,101 or in the US via MODEMS™(. It has been administered over the telephone90,53. A modified version of the Oswestry Disability Questionnaire has been published by the North American Spine Society (NASS) 19. This version, which is available from also contains a pain diagram, questions from the SF36 health questionnaire, questions on neurological symptoms and on the “bothersomeness” of back pain, and a modification of the ODI. The modifications introduced were designed to clarify the wording of some individual response items. This version also specifies that the respondent should answer the questions in relation to ‘the past week’ (the original instrument is not specific on this point, 2.0 uses “today”). The NASS version is part of the battery of outcome measures recommended by Deyo et al 199823. Psychometric data are limited on the NASS instrument, though we are aware that it is being used in a number of large studies, and that psychometric data will become available in due course. This version has led to confusion over the scoring system in recent presentations from North America. The reader is referred to Fairbank and Pynsent (2000) for further details31

The wording and scoring system of ODI version 2.0 is reproduced in Appendix 2. It has been translated into at least 9 languages. Non-English language citations are shown in table 2. The authors of the original publication hold the copyright of the ODI30. They support the widespread use of version 2.0, and neither the authors nor Spine require permission for its use. However, permission from the authors (JF) is required if modifications to the instrument are being considered. Validated translation of ODI 2.0 into other languages is strongly encouraged, though the authors ask to be consulted when such translations are undertaken.

|Language |Citation(s) |

|Danish |15,88,87,143 |

|Dutch |143 |

|Finnish |54,56,40,39,73,42,69,74,70,46-48,52,74,83,84,128-130,41,50,51,5|

| |3,71,72,55,68,75 |

| |115-117,151,86,62,61,145 |

|French |28,143 |

| |78,89 |

|German |2,95,149 |

| |9,16,148 |

|Greek |7 |

|Norwegian |29,36,35,114,131 |

|Spanish |76 |

|Swedish |112,110,111 |

Table 2. Non English language citations of the ODI

Face and Content Validity of the ODI

These address the extent to which the scale appears to be assessing the intended attributes. 25 patients in their first attack of low back pain who might reasonably be expected to improve over a period were shown to do so30. Beuerskins and others carried out a more sophisticated analysis of 81 patients over a 5 weeks period confirming an expected improvement in ODI scores6. Their study allows calculation of an effect size of 0.818. However Kopec66 reported an effect size of only 0.07. Fisher and Johnson performed one of the most detailed validations of the questionnaire (version 2.0). They related patient behaviour whilst they were completing this and other questionnaires to their responses within the questionnaires32. Two sections of the questionnaires (sitting and walking) did correlate with patient response but was less satisfactory for a third (lifting).

Construct validity of the ODI

The wording of the ODI was designed on the basis of patients complaints and symptoms with chronic low back pain. The ODI shows moderate correlation with pain measures such as a visual analogue scale (n=94, r=0.62)39 and the McGill pain questionnaire94,43.

The ODI has been used to validate the Pain Disability Index108 123 39,42; the Low Back Outcome Score37; The Manniche Scale88,87; the Aberdeen score107; a new German language scale2; the Curtin Scale45; and a functional capacity evaluation63.

The ODI correlates with SF3638. ODI is a better predictor of return to work than two different mechanical methods of lumbar spine assessment96,82. It predicts isokinetic performance60; isometric endurance77; and with sitting and standing (but not lifting) in a secret observation study32. In the Mackenzie system of evaluation, “centralisers” show improving ODI scores125. Physical tests correlate with the ODI42 but range of movement does not41.

Internal Consistency of the ODI

Strong et al (using version 1.0) found Cronbach's ( to be 0.71123, Fisher and Johnson (using version 2.0) 0.7632 and Kopec 0.8766. All these investigations show an “acceptable” degree of internal consistency.

Reproducibility of the ODI

In the original study chronic low back pain patients were tested twice at a 24 hours interval (n=22, r= 0.99)30. This may include a memory effect. If the test/retest interval is extended to 4 days the correlation of scores drops to n=22, r=0.9166 and, if retested after a week, n= 22, r=0.8339. The disadvantage of increasing the time interval is that natural symptom fluctuation may also be an influence. Grevitt (personal communication) found a poorer test/retest correlation in a study where he mailed versions of the questionnaire to patients to fill in and then asked them to fill in the questionnaire again in a different format when they attended as out-patients.

Responsiveness of the ODI

Receiver Operating Characteristic (ROC) is a concept used to explore “the diagnostic test performance of an instrument” or the ability of the instrument to detect change21, where its sensitivity is plotted against (1 minus specificity). This allows the ability of the instrument to detect change to be investigated. The ROC index (D() for the ODI was found to be 0.76, a score which is acceptable but not as good as the RDQ scale. This is perhaps not surprising in a population of not too severely affected patients (mean ODI=26.2, sd=13.5)6, 82. The ROC index has not been calculated for the ODI in a group of more severely affected patients. As the ROC curve depends on sensitivity and specificity, there is an inherent assumption that a “true disability” is known. This may be difficult to justify21.

Meade110 chose 4 points as the minimum difference in mean scores between groups carrying clinical significance. The FDA has chosen a minimum 15 point change in spinal fusion patients before surgery and at follow-up (Lipscombe, Personal Communication). Table 2 shows change in weighted means calculated from publications reporting ODI before and after treatment in various subgroups of patients. Large changes in score are seen in primary back pain patients and the least in those with spinal metastases. More work is needed in this area.

Comparison between the Roland Disability Questionnaire and the Oswestry Disability Index.

It is important to emphasise that differences between these instruments are not great. Both are widely used, have been extensively tested, and are applicable to a wide variety of settings. The situation where a choice between the two instruments would be most clear cut would be where a validated translation exists for one, but not the other.

Both were originally designed for paper administration. The RDQ has been widely administered over the telephone. While the ODI can be administered by phone, the multiple nature of the response items makes this more difficult.

Floor and ceiling effects may influence the choice of instruments. A greater proportion of patients score in the top half of the distribution of RDQ scores than that of ODI scores 65. At high levels of disability, the ODI may still show change where RDQ scores are maximal. At the other end of the scale, Roland scores may still discriminate when ODI scores are at a minimum1 . We therefore recommend the ODI where patients are likely to have persistent severe disability, and the RDQ for populations are likely to have relatively little disability. However, for most populations, both instruments will function satisfactorily in this respect.

RDQ and ODI scores are highly correlated, with similar test re-test reliability and internal consistency 1,17, 64 In terms of discriminating power, including ability to detect change over time, Stratford et al (1994)121 found that the properties of the two instruments were very similar. Other authors have reported that the ODI performs better 79 or the reverse 5, or that the result depends on the exact comparison being made 64. It is difficult to compare these studies in detail, since they relate to different patient populations.

Normative data for RDQ and ODI

In table 3, we have included normative data to give clinicians an idea of the sort of scores that that they can expect in a variety of clinical situations The table includes studies in which RDQ and ODI scores were both measured on the same group of patients to allow comparison between scores on the two instruments.

| |RDQ |ODI |

|Patients recruited to trial, less than |10.9, 0-22, 4.7 |33.0, 4-70, 14.7 |

|3/12 pain, no radiculopathy 79 (Canada), | | |

|mean values, range, standard deviation | | |

|Patients with EMG evidence of |14.2, 0-24, 5.2 |49.1, 6-86, 17.1 |

|radiculopathy in hospital clinic 79 | | |

|(Canada), mean values, range, standard | | |

|deviation | | |

|Patients referred to physiotherapy, |Enrolment:11.8, 6.2 |Enrolment: 40.5, 17.8 |

|Canada 121 Mean values and standard |4 weeks later: 7.1, 5.7 |4 weeks later: 24.4, 15.5 |

|deviations at enrolment (mean duration | | |

|symptoms 48 days) and 4 week follow up | | |

|Patients with non-specific low back pain |12.1, 7.5 |27.6, 21.9 |

|for >6 weeks. Mean score at baseline and |Improved patients 12.1, 4.3 |Improved patients 26.2, 14.3 |

|5 weeks. 6 |Non-improved 11.8, 10.6 |Non-improved 29.1, 29.5 |

Table 3. RDQ and ODI scores measured simultaneously in a range of patient populations

Summary

The Roland-Morris Disability Scale is a short and simple method of assessing self rated physical function in patients with back pain. Its ease of use makes it suitable for following progress of individual patients in clinical settings, and for combining with other measures of function (e.g. psychological or work disability) in research settings. The ODI is likewise an effective method of measuring disability in back pain patients with a wide degree of severity and aetiology. Both instruments have stood the test of time and been used in a wide variety of clinical situations, in the UK, USA and many other countries.

Both instruments perform as well most other currently available instruments, and better than some. The RDQ may be better suited to settings where patients have mild to moderate disability, and the ODI to situations where patients may have persistent severe disability. The availability of the two instruments in a wide range of languages permits comparison between studies carried out in a wide range of countries.

Note that some of the text of this paper has been derived from Fairbank and Pynsent 2000 31

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Appendix 1. The Roland-Morris Disability Questionnaire

When you back hurts, you may find it difficult to do some things you normally do.

This list contains sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because the describe you today. As you read the list, think of yourself today. When you read a sentence that describes you today, put a tick against it. If the sentence does not describe you, then leave the space blank and go on to the next on. Remember, only tick the sentence if you are sure it describes you today.

Scoring the RDQ. The score is the total number of items checked – i.e. from a minimum of 0 to a maximum of 24.

1. I stay at home most of the time because of my back.

2. I change position frequently to try and get my back comfortable.

3. I walk more slowly than usual because of my back.

4. Because of my back I am not doing any of the jobs that I usually do around the house.

5. Because of my back, I use a handrail to get upstairs.

6. Because of my back, I lie down to rest more often.

7. Because of my back, I have to hold on to something to get out of an easy chair.

8. Because of my back, I try to get other people to do things for me.

9. I get dressed more slowly then usual because of my back.

10. I only stand for short periods of time because of my back.

11. Because of my back, I try not to bend or kneel down.

12. I find it difficult to get out of a chair because of my back.

13. My back is painful almost all the time.

14. I find it difficult to turn over in bed because of my back.

15. My appetite is not very good because of my back pain.

16. I have trouble putting on my socks (or stockings) because of the pain in my back.

17. I only walk short distances because of my back.

18. I sleep less well because of my back.

19. Because of my back pain, I get dressed with help from someone else.

20. I sit down for most of the day because of my back.

21. I avoid heavy jobs around the house because of my back.

22. Because of my back pain, I am more irritable and bad tempered with people than usual.

23. Because of my back, I go upstairs more slowly than usual.

24. I stay in bed most of the time because of my back.

Appendix 2. Oswestry Disability Index (2.0)

Could you please complete this questionnaire It is designed to give us information as to how your back (or leg) trouble has affected your ability to manage in everyday life.

Please answer every section. Mark one box only in each section that most closely describes you today.

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 extra pain.

( I can look after myself normally but it is very painful.

( It is painful to look after myself and I am slow and careful.

( I need some help but manage most of my personal care.

( I need help every day in most aspects of self care.

( I do not get dressed, wash with difficulty and stay in bed.

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 but I can manage if they are conveniently positioned, e.g. on a table.

( Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned.

( 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 1 mile.

( Pain prevents me walking more than than of a mile.

( Pain prevents me walking more than 100 yards.

( 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 an hour.

( Pain prevents me from sitting for more than 10 minutes.

( 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 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 extra pain.

( 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 from limiting 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 under 30 minutes.

( Pain prevents me from travelling except to receive treatment

Scoring the ODI

For each section of 6 statements the total score is 5; if the first statement is marked the score = 0; if the last statement is marked it = 5. Intervening statements are scored according to rank. If more than one box is marked in each section, take the highest score. If all 10 sections are completed the score is calculated as follows:

Example: if 16 (total scored) out of 50 (total possible score) ( 100 = 32%

If one section is missed (or not applicable) the score is calculated:

Example:16 (total scored) / 45 (total possible score) ( 100 = 35.5%

So the final score may be summarised as:

(total score / (5 ( number of questions answered)) ( 100 %

We suggest rounding the percentage to a whole number for convenience.

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