Developing a Functional Staging to Assist Clinical Interpretation of the Oswestry Disability Indexs
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 12, Issue 1
Abstract
Objective: Our purposes were to: (a) examine the psychometric properties of 10-item Oswestry Disability Index 2.0 (ODI) (0-100) questionnaire using the Rasch analysis, and (b) develop a functional staging approach to guide clinical interpretation of the patient’s improvement by interpreting ODI scores. Participants. A sample of 3,460 patients with orthopedic lumbar spine impairments seeking outpatient physical therapy in 274 clinics. Methods: We examined the rating scale structure, item difficulty hierarchy, item fit, person-item match, separation index, differential item functioning (DIF) by demographic variables, and unidimensionality. Additionally, applied the keyform method to develop a functional staging. Results: The ODI questionnaire has sufficient psychometric properties. ‘Lifting’ appeared to be the most difficult item. ‘Personal care” was the easiest. The coverage of ODI items matched well with the patient functional abilities. With a separation index equaled to 2.15, the ODI items can differentiate persons into 3.2 statistically distinct person strata. ODI items were free of DIF by gender and impairment, but four to five items were suggestive of DIF by age group and symptom acuity. Factor analysis supported one-factor solution; however, the first factor explained only 49.6% of the total variance. We provided an example of functional staging application. Conclusion: Results supported the clinical usage of the ODI questionnaire in outpatient (orthopedic) rehabilitation service.Improvement in pain and function are two essential outcomes in orthopedic surgery and spine management. Patient-reported outcomes designed to assess levels of pain and function have become pivotal in evaluating orthopedic interventions [1]. Among them, the change scores in Oswestry Disability Index (ODI) [2] have been used widely as the objective measurement of functional disabilities of lumbar spine function in both medical research and clinical practice. The popularity leads to the existence of more than 27 versions of ODI adaptations in 24 different languages/cultures for application [3]. Additionally, the order of item difficulty could be used as a rule of progressive management program [11,12]. Previous studies supported the psychometric properties of ODI. The reliability of ODI was supported by moderate to high reliability coefficients: test-retest reliability (Intraclass correlation [ICC] = 0.70-0.92 [13-16], intrarater reliability (ICC = 0.93) [17], internal consistency (Cronbach’s alpha = 0.78-0.97) [13,15-19]. Findings of the ODI also demonstrate high correlations with other measures, such as visual analogue pain intensity scale (r = 0.67), Roland-Morris Disability Questionnaire score (r=0.71- 0.76) [13,15], and short-form-36 (r = 0.25-0.46) [20]. Factor analysis supports its unidimensionality [13,18,21]. Furthermore, responsiveness studies report several cutoff thresholds to classify patient’s improvement [14,22]. Psychometric examinations at the item level have been performed [1,9,11,23-25]. However, prior studies show great variations of item difficulty hierarchical order, especially the order of items at the middle difficulty level.The questionnaire has been used: a. To measure functional improvement following spine surgeries [4-6]; b. To assess the benefits and efficacy of stretching exercises and spinal manipulative therapy in patients who suffer from low back pain [7,8]; and c. in functional capacity evaluations that can affect eligibility for ongoing benefits and rehabilitation funding [9]. The ODI is a simple disability scale that uses 10 items to measure the disability level. It reveals functional capacity with reallife physical activity [10].
Authors and Affiliations
Ying-Chih Wang, Jay Kapellusch, Bhagwant Sindhu, Leigh Lehman, Xiaoyan Li, Sheng-Che Yen
Keywords
Related Articles
- EP ID EP592722
- DOI 10.26717/BJSTR.2018.12.002200
- Views 188
- Downloads 0
The Effects of Exogenous Modulation on the Peripheral Nerve Regeneration after Injury and Primary Surgical Repair
Peripheral nerve injury can be surgically treated, but functional recovery is still unsatisfactory. That is why additional methods that can be applied after surgical repair and which modulate nerve regeneration are sough...
Neutrophil-to-Lymphocyte Ratio: A Systemic Inflammatory Index for Primary Diagnosis and Prognosis of Cholangiocarcinoma
Cholangiocarcinoma (CCA) is a major cause of cancer death in the northeastern Thailand. A primary diagnosis for CCA is essential to reduce the mortality of CCA patients. In this study, the Neutrophil-to-Lymphocyte ratio...
Malignant Transformation of Exophytic Sinonasal Papilloma: Case Report
Malignant transformation of exophytic sinonasal papilloma (SP) is exceptionally rare. The authors present a case of a 48 years old woman who presented to hospital with unilateral nasal obstruction, a tissue mass in the r...
Targeting Hyaluronan in Vascular Diseases with Special Reference to Diabetic Macroangiopathy
Vascular Extracellular Matrix (ECM) is a dynamic structure, which regulates blood vessel morphogenesis, provides organizational stability, and modulates various aspects of cell behavior [1]. Hyaluronan (HA) represents on...
Therapeutic Approach to Diabetes Mellitus Type 2 in People with Progressive Weight Gain: A Unique Case Study (Ucs)
Introduction Diabetes Mellitus (DM) is an important public health problem of our time [1]. According to European Health Survey in Spain, diabetes is 6.8% of the diagnosed chronic disease in people over the age of 15 in 2...