The Roland-Morris Disability Questionnaire and the … paper.doc · Web viewTitle The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire Author Jeremy

The Roland-Morris Disability Questionnaire and the Oswestry Disability

Questionnaire

Martin RolandNational 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.

[email protected]

Jeremy FairbankNuffield Orthopaedic Centre, Oxford OX3 7LD, United Kingdom

Tel. +44 1865 741155. Fax +44 1865 744455.

[email protected]

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.

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Oswestry and Roland-Morris

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

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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.

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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.

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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.

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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

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(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 groups

Weighted mean ODI

S.D. / F Sources Sources not

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score range used 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,

52,63,50,53,62

,81,112,61,82,

110,111

86

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,

121,131,135,1

1,70,85,139,8,

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

,13,38,131

73,69,

74,70-

72,114,

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

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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

www.modems.org 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

MODEMS™, PO Box 2354, Des Plaines, IL 60017-2354

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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-

130,41,50,51,53,71,72,55,68,75

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

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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.

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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

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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

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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 3/12 pain,

no radiculopathy 79

(Canada), mean values,

range, standard

deviation

10.9, 0-22, 4.7 33.0, 4-70, 14.7

Patients with EMG

evidence of

radiculopathy in hospital

clinic 79 (Canada),

mean values, range,

14.2, 0-24, 5.2 49.1, 6-86, 17.1

- 14 -

standard deviation

Patients referred to

physiotherapy, Canada

121 Mean values and

standard deviations at

enrolment (mean

duration symptoms 48

days) and 4 week follow

up

Enrolment:11.8, 6.2

4 weeks later: 7.1, 5.7

Enrolment: 40.5, 17.8

4 weeks later: 24.4,

15.5

Patients with non-

specific low back pain

for >6 weeks. Mean

score at baseline and 5

weeks. 6

12.1, 7.5

Improved patients 12.1,

4.3

Non-improved 11.8,

10.6

27.6, 21.9

Improved patients 26.2,

14.3

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

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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.

- 36 -

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.

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

- 38 -

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.

- 39 -


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.

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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

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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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The Roland-Morris Disability Questionnaire and the … paper.doc · Web viewTitle The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire Author Jeremy

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