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Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations

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An Erratum to this article was published on 22 November 2006

Abstract

In studies evaluating the efficacy of clinical interventions, it is of paramount importance that the functional outcome measures are responsive to clinically relevant change. Knowledge thereof is in fact essential for the choice of instrument in clinical trials and for clinical decision-making. This article endeavours to investigate the sensitivity, specificity and clinically significant improvement (responsiveness) of the Danish version of the Oswestry disability index (ODI) in two back pain populations. Two hundred and thirty three patients with low back pain (LBP) and/or leg pain completed a questionnaire booklet at baseline and 8 weeks follow-up. Half of the patients were seen in the primary (PrS) and half in the secondary sectors (SeS) of the Danish Health Care System. The booklet contained the Danish version of the ODI, along with the Roland Morris Questionnaire, the LBP Rating Scale, the SF36 (physical function and bodily pain scales) and a global pain rating. At follow-up, a 7-point transition question (TQ) of patient perceived change and a numeric rating scale relating to the importance of the change were included. Responsiveness was operationalised using three strategies: change scores, standardised response means (SRM) and receiver operating characteristic (ROC) analyses. All methods revealed acceptable responsiveness of the ODI in the two patient populations which was comparable to the external instruments. SRM of the ODI change scores at 2 months follow-up was 1.0 for PrS patients and 0.3 for SeS (raw and percentage). A minimum clinically important change (MCID) from baseline score was established at 9 points (71%) for PrS patients and 8 points (27%) for SeS patients using ROC analyses. This was dependable on the baseline entry score with the MCID increasing with 5 points for every 10 points increase in the baseline score. We conclude that the Danish version of the ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in low back pain patients receiving conservative care in both the primary and secondary sector.

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Notes

  1. It might seem odd that the average of 13 and 10 points for the PrS and SeS patients does not equal the 15 point for the whole population, however, this is an example of Simpson’s Paradox.

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Acknowledgments

We thank Jytte Johannesen and Ida Bhanderi for administering the questionnaires. Furthermore, we would like to thank the management and staff at Backcenter Funen for their enthusiastic participation in the project. A special thanks to the seven chiropractic clinics for their involvement in recruiting patients for the study.

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Authors and Affiliations

  1. Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Henrik Hein Lauridsen, Jan Hartvigsen & Niels Grunnet-Nilsson

  2. Clinical Locomotion Science, Odense, Denmark

    Henrik Hein Lauridsen, Jan Hartvigsen, Claus Manniche & Niels Grunnet-Nilsson

  3. Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark

    Jan Hartvigsen

  4. Backcenter Funen, Ringe, Denmark

    Claus Manniche

  5. Department of Statistics, University of Southern Denmark, Odense, Denmark

    Lars Korsholm

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  1. Henrik Hein Lauridsen
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  2. Jan Hartvigsen
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  4. Lars Korsholm
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  5. Niels Grunnet-Nilsson
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Correspondence to Henrik Hein Lauridsen.

Additional information

Part 1 of this article is available at: http://dx.doi.org/10.1007/s00586-006-0117-9

An erratum to this article can be found at http://dx.doi.org/10.1007/s00586-006-0260-3

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Lauridsen, H.H., Hartvigsen, J., Manniche, C. et al. Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations. Eur Spine J 15, 1717–1728 (2006). https://doi.org/10.1007/s00586-006-0128-6

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