European Spine Journal

, Volume 27, Issue 7, pp 1604–1613 | Cite as

Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review

  • Annette Bennedsgaard Jespersen
  • Malin Eleonora av Kák Gustafsson



The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient’s walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe patient’s walking ability. Objective methods to assess walking capacity and performance is being investigated and used alongside the traditional use of PROs. This review of the literature was made to provide an overview of relations between the ODI and outcome measures of walking capacity and performance in spinal stenosis research, and to provide a strategy for improving such measures in future research.


The review was conducted according to the Prisma Statement. In February 2017, a search was performed in Pubmed, Embase and Cochrane database. Authors independently screened articles by title, abstract, and full text, and studies were included if both authors agreed. Articles with correlation analysis between the ODI, walking capacity and performance measures by accelerometer or GPS were included.


The results support a correlation between the ODI and walking capacity measures. The available studies using ODI and accelerometers were too few to reach a conclusion regarding correlation between ODI and walking performance. No articles with GPS measure were identified.


The ODI should not stand alone when evaluating walking limitations in patients with lumbar spinal stenosis. To enable a comprehensive assessment of walking ability, a walking test should be used to assess walking capacity and accelerometers should be investigated and standardized in measuring walking performance.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Lumbar spinal stenosis The Oswestry Disability Index Walking capacity Walking performance WHO 



This review has not received any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

586_2018_5520_MOESM1_ESM.pptx (414 kb)
Supplementary material 1 (PPTX 413 kb)
586_2018_5520_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 16 kb)
586_2018_5520_MOESM3_ESM.docx (60 kb)
Supplementary material 3 (DOCX 60 kb)


  1. 1.
    Verbiest H (1980) Stenosis of the lumbar vertebral canal and sciatica. Neurosurg Rev 3:75–89CrossRefPubMedGoogle Scholar
  2. 2.
    Ammendolia C, Stuber K, Tomkins-Lane C, Schneider M, Rampersaud YR, Furlan AD, Kennedy CA (2014) What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23:1282–1301. CrossRefGoogle Scholar
  3. 3.
    de Vet HCW, Terwee CB, Mokkink LB, Knol DJ (2011) Measurement in medicine. A practical guide. Cambridge University Press, Cambridge. CrossRefGoogle Scholar
  4. 4.
    Lassere MN (2006) A users guide to measurement in medicine. Osteoarthr Cartil 14(Suppl A):A10–A13. CrossRefPubMedGoogle Scholar
  5. 5.
    Organisation WH (2003) ICF Checklist. In: Version 21a, Clinician FormGoogle Scholar
  6. 6.
    Organisation WH (2002) Towards a Common Language for Functioning, Disability and Health ICFGoogle Scholar
  7. 7.
    Tomkins CC, Battie MC, Rogers T, Jiang H, Petersen S (2009) A criterion measure of walking capacity in lumbar spinal stenosis and its comparison with a treadmill protocol. Spine 34:2444–2449. CrossRefPubMedGoogle Scholar
  8. 8.
    Pratt RK, Fairbank JC, Virr A (2002) The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 27:84–91CrossRefPubMedGoogle Scholar
  9. 9.
    Deen HG Jr, Zimmerman RS, Lyons MK, McPhee MC, Verheijde JL, Lemens SM (2000) Test–retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 75:1002–1007CrossRefPubMedGoogle Scholar
  10. 10.
    Rossier P, Wade DT (2001) Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil 82:9–13. CrossRefPubMedGoogle Scholar
  11. 11.
    Singh A, Crockard HA (1999) Quantitative assessment of cervical spondylotic myelopathy by a simple walking test. Lancet (London, England) 354:370–373. CrossRefGoogle Scholar
  12. 12.
    Gibbons WJ, Fruchter N, Sloan S, Levy RD (2001) Reference values for a multiple repetition 6-min walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 21:87–93CrossRefPubMedGoogle Scholar
  13. 13.
    Tomkins-Lane CC, Haig AJ (2012) A review of activity monitors as a new technology for objectifying function in lumbar spinal stenosis. J Back Musculoskelet Rehabil 25:177–185. CrossRefPubMedGoogle Scholar
  14. 14.
    Welk GJ (2002) Physical activity assessments for health-related research. Human Kinetics, ChampaignGoogle Scholar
  15. 15.
    Davis MG, Fox KR (2007) Physical activity patterns assessed by accelerometry in older people. Eur J Appl Physiol 100:581–589. CrossRefPubMedGoogle Scholar
  16. 16.
    Cavanaugh JT, Coleman KL, Gaines JM, Laing L, Morey MC (2007) Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults. J Am Geriatr Soc 55:120–124. CrossRefPubMedGoogle Scholar
  17. 17.
    Winter CC, Brandes M, Müller C, Schubert T, Ringling M, Hillmann A et al. (2010) Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord 11:233CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gilmore S, McClelland JA, Davidson M (2016) Does walking after lumbar spinal surgery predict recovery of function at 6 months? Protocol for a prospective cohort study. BMC Musculoskelet Disord 17:472. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Skotte J, Korshoj M, Kristiansen J, Hanisch C, Holtermann A (2014) Detection of physical activity types using triaxial accelerometers. J Phys Act Health 11:76–84. CrossRefPubMedGoogle Scholar
  20. 20.
    Stemland I, Ingebrigtsen J, Christiansen CS, Jensen BR, Hanisch C, Skotte J, Holtermann A (2015) Validity of the Acti4 method for detection of physical activity types in free-living settings: comparison with video analysis. Ergonomics 58:953–965. CrossRefPubMedGoogle Scholar
  21. 21.
    Allet L, Knols RH, Shirato K, de Bruin ED (2010) Wearable systems for monitoring mobility-related activities in chronic disease: a systematic review. Sensors (Basel, Switzerland) 10:9026–9052. CrossRefGoogle Scholar
  22. 22.
    Granat M, Clarke C, Holdsworth R, Stansfield B, Dall P (2015) Quantifying the cadence of free-living walking using event-based analysis. Gait Posture 42:85–90. CrossRefPubMedGoogle Scholar
  23. 23.
    Barzilay Y, Noam S, Meir L, Gail A, Amit B, Michal I, Vaccaro AR, Leon K (2011) Assessing the outcomes of spine surgery using global positioning systems. Spine 36:E263–E267. CrossRefPubMedGoogle Scholar
  24. 24.
    Maddison R, Jiang Y, Vander Hoorn S, Exeter D, Mhurchu CN, Dorey E (2010) Describing patterns of physical activity in adolescents using global positioning systems and accelerometry. Pediatr Exerc Sci 22:392–407CrossRefPubMedGoogle Scholar
  25. 25.
    Maddison R, Ni Mhurchu C (2009) Global positioning system: a new opportunity in physical activity measurement. Int J Behav Nutr Phys Act 6:73. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Roland M, Fairbank J (2000) The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine 25:3115–3124CrossRefPubMedGoogle Scholar
  27. 27.
    Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 21:796–803CrossRefPubMedGoogle Scholar
  28. 28.
    Tomkins CC, Battie MC, Hu R (2007) Construct validity of the physical function scale of the Swiss spinal stenosis questionnaire for the measurement of walking capacity. Spine 32:1896–1901. CrossRefPubMedGoogle Scholar
  29. 29.
    Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144CrossRefPubMedGoogle Scholar
  30. 30.
    Heinemann A, Raad J, Akuthota V, Segal N, Nitsch KP, Rho M, Chan L, Casey E, Press J, Sowa G, Moore J (2017) Scoping review to develop common data elements for lumbar spinal stenosis. Spine J Off J N Am Spine Soc. CrossRefGoogle Scholar
  31. 31.
    Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt MJ, Lee MJ (2011) Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine 36:S54–S68. CrossRefPubMedGoogle Scholar
  32. 32.
    Fairbank JCCJDJ et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  33. 33.
    Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25:2940–2952 (discussion 2952) CrossRefPubMedGoogle Scholar
  34. 34.
    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, medical outcomes study questionnaire short form 36, and pain scales. Spine J Off J N Am Spine Soc 8:968–974. CrossRefGoogle Scholar
  35. 35.
    Fairbank JC (2014) Why are there different versions of the Oswestry Disability Index? J Neurosurg Spine 20:83–86. CrossRefPubMedGoogle Scholar
  36. 36.
    Sinikallio S, Aalto T, Airaksinen O, Herno A, Kroger H, Savolainen S, Turunen V, Viinamaki H (2007) Lumbar spinal stenosis patients are satisfied with short-term results of surgery—younger age, symptom severity, disability and depression decrease satisfaction. Disabil Rehabil 29:537–544. CrossRefPubMedGoogle Scholar
  37. 37.
    Okoro T, Qureshi A, Sell B, Sell P (2010) The accuracy of assessment of walking distance in the elective spinal outpatients setting. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19:279–282. CrossRefGoogle Scholar
  38. 38.
    Werneke M (2016) A proposed set of metrics for standardized outcome reporting in the management of low back pain. Acta Orthop 87:88. CrossRefPubMedGoogle Scholar
  39. 39.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg (London, England) 8:336–341. CrossRefGoogle Scholar
  40. 40.
    Kellar SP, Kelvin EA, Munro BH (2012) Munro’s statistical methods for health care research. Wolters Kluwer Health/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  41. 41.
    Domholdt E (1993) Physical therapy research: principles and applications. W. B. Saunders, PhiladelphiaGoogle Scholar
  42. 42.
    Gross DP, Battie MC (2003) Construct validity of a kinesiophysical functional capacity evaluation administered within a worker’s compensation environment. J Occup Rehabil 13:287–295CrossRefPubMedGoogle Scholar
  43. 43.
    Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 19:539–549. CrossRefGoogle Scholar
  44. 44.
    Centre for Evidence Based Medicine (2017) Diagnostic study appraisal worksheet. Accessed 14 Aug 2017
  45. 45.
    Tomkins-Lane CC, Battie MC, Macedo LG (2014) Longitudinal construct validity and responsiveness of measures of walking capacity in individuals with lumbar spinal stenosis. Spine J Off J N Am Spine Soc 14:1936–1943. CrossRefGoogle Scholar
  46. 46.
    Tomkins-Lane CC, Battie MC (2013) Predictors of objectively measured walking capacity in people with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil 26:345–352. CrossRefPubMedGoogle Scholar
  47. 47.
    Rainville J, Childs LA, Pena EB, Suri P, Limke JC, Jouve C, Hunter DJ (2012) Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study. Spine J Off J N Am Spine Soc 12:101–109. CrossRefGoogle Scholar
  48. 48.
    Barz T, Melloh M, Staub L, Roeder C, Lange J, Smiszek FG, Theis JC, Merk HR (2008) The diagnostic value of a treadmill test in predicting lumbar spinal stenosis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 17:686–690. CrossRefGoogle Scholar
  49. 49.
    Tomkins-Lane CC, Battie MC (2010) Validity and reproducibility of self-report measures of walking capacity in lumbar spinal stenosis. Spine 35:2097–2102. CrossRefPubMedGoogle Scholar
  50. 50.
    Prasad BC, Ramesh Chandra VV, Devi BV, Chivukula SS, Pundarikakshaiah K (2016) Clinical, radiological, and functional evaluation of surgical treatment in degenerative lumbar canal stenosis. BioMed Res Int 64:677–683.
  51. 51.
    Pryce R, Johnson M, Goytan M, Passmore S, Berrington N, Kriellaars D (2012) Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis. Spine 37:1316–1323. CrossRefPubMedGoogle Scholar
  52. 52.
    Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H, Liem D, Rosenbaum D, Bullmann V (2010) Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19:1855–1864. CrossRefGoogle Scholar
  53. 53.
    Tomkins-Lane CC, Conway J, Hepler C, Haig AJ (2012) Changes in objectively measured physical activity (performance) after epidural steroid injection for lumbar spinal stenosis. Arch Phys Med Rehabil 93:2008–2014. CrossRefPubMedGoogle Scholar
  54. 54.
    Conway J, Tomkins CC, Haig AJ (2011) Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures. Spine J Off J N Am Spine Soc 11:816–823. CrossRefGoogle Scholar
  55. 55.
    Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, Kroger H, Andrade J, Jimenez R, Tapaninaho A, Turunen V, Savolainen S, Airaksinen O (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine 31:E648–E663. CrossRefPubMedGoogle Scholar
  56. 56.
    Papadakis NC, Christakis DG, Tzagarakis GN, Chlouverakis GI, Kampanis NA, Stergiopoulos KN, Katonis PG (2009) Gait variability measurements in lumbar spinal stenosis patients: part A. Comparison with healthy subjects. Physiol Meas 30:1171–1186. CrossRefPubMedGoogle Scholar
  57. 57.
    Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS (2011) A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skelet Radiol 40:1033–1039. CrossRefGoogle Scholar
  58. 58.
    Lurie J, Tomkins-Lane C (2016) Management of lumbar spinal stenosis. BMJ (Clinical research ed) 352:h6234. CrossRefGoogle Scholar
  59. 59.
    de Schepper EIT, Overdevest GM, Suri P, Peul WC, Oei EHG, Koes BW, Bierma-Zeinstra SMA, Luijsterburg PAJ (2013) Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine 38:E469–E481. CrossRefPubMedGoogle Scholar
  60. 60.
    Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS (2010) A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol 194:1095–1098. CrossRefPubMedGoogle Scholar
  61. 61.
    Normahani P, Kwasnicki R, Bicknell C, Allen L, Jenkins MP, Gibbs R, Cheshire N, Darzi A, Riga C (2017) Wearable sensor technology efficacy in peripheral vascular disease (wSTEP): a randomized controlled trial. Ann Surg. PubMedCrossRefGoogle Scholar
  62. 62.
    Del Din S, Godfrey A, Rochester L (2016) Validation of an accelerometer to quantify a comprehensive battery of gait characteristics in healthy older adults and Parkinson’s disease: toward clinical and at home use. IEEE J Biomed Health Inform 20:838–847. CrossRefPubMedGoogle Scholar
  63. 63.
    Gernigon M, Le Faucheur A, Fradin D, Noury-Desvaux B, Landron C, Mahe G, Abraham P (2015) Global positioning system use in the community to evaluate improvements in walking after revascularization: a prospective multicenter study with 6-month follow-up in patients with peripheral arterial disease. Medicine 94:e838. CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Krenn PJ, Titze S, Oja P, Jones A, Ogilvie D (2011) Use of global positioning systems to study physical activity and the environment: a systematic review. Am J Prev Med 41:508–515. CrossRefPubMedGoogle Scholar
  65. 65.
    Schneller MB, Bentsen P, Nielsen G, Brond JC, Ried-Larsen M, Mygind E, Schipperijn J (2017) Measuring children’s physical activity: compliance using skin-taped accelerometers. Med Sci Sports Exerc 49:1261–1269. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Regional Health Research, Center for Spine Surgery and Research, MiddelfartRegion of Southern DenmarkMiddelfartDenmark
  2. 2.Department of Regional Health Research, Center for Spine Surgery and Research, MiddelfartRegion of Southern DenmarkOdenseDenmark

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