Literature Decoded

Living reprintoriginally published in BMC Surgery 2024CC BY 4.0Read the version of record Opt out

Literature DecodedLiving reprint
Living reprint · journal article Journal version available

Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery

Study first published in BMC Surgery (2024), reprinted in full under its CC BY 4.0 licence.

Konsta Koivunen1*, Sara Widbom-Kolhanen2, Katri Pernaa3, Jari Arokoski4, Mikhail Saltychev5

1https://ror.org/05dbzj528grid.410552.70000 0004 0628 215XClinical Division, Turku University Hospital and University of Turku, Turku, 20540 Finland2Department of Surgery, Satasairaala Hospital, Pori, Finland3grid.410552.70000 0004 0628 215XDepartment of Orthopedics, Turku University Hospital and University of Turku, Turku, Finland4https://ror.org/02e8hzf44grid.15485.3d0000 0000 9950 5666Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and Helsinki University, Turku, Finland5grid.410552.70000 0004 0628 215XDepartment of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland*Corresponding author

Reprinted 2026-10-01 16 min read Living reprint · journal article Version of record: BMC Surgery 2024Licence: CC BY 4.0

Reading mode
In plain languageStudy first published in BMC Surgery (2024), reprinted in full under its CC BY 4.0 licence.

Study first published in BMC Surgery (2024), reprinted in full under its CC BY 4.0 licence.

No plain-language summary has been written for this reprint yet. The authors' abstract and full text follow, unchanged apart from layout.

Educational summary of research findings; not medical advice. Discuss care decisions with a qualified clinician.

Bottom line

What the evidence supports

How to read it

No plain-language summary has been written for this reprint yet. The authors' abstract and full text follow, unchanged apart from layout.

Limitations

The findings apply to the included study populations and may not generalise to every person or setting.

Disclaimer

Educational summary of research findings; not medical advice. Discuss care decisions with a qualified clinician.

The paper

Full manuscript

Abstract

Background

The objective of this study was to explore the internal consistency and factor structure of the Oswestry Disability Index among patients undergoing spinal surgery. The sample consisted of 1,515 patients who underwent lumbar spinal surgery at a university hospital between 2018 and 2021.

Methods

The patients responded to the Oswestry Disability Index within 2 months before surgery. Cronbach’s alpha was used to assess the internal consistency. The factor structure was evaluated using exploratory and confirmatory factor analyses.

Results

The average age of 1,515 patients was 58.5 (SD 15.8) years and 53% were women. The mean ODI score was 43.4% (SD 17.4%). Of the patients, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots. The internal consistency of the Oswestry Disability Index was found to be good, with an alpha of 0.87 (95% CL 0.86 to 0.88). Exploratory factor analysis resulted in unidimensional structure. Item loadings on this retained factor were moderate to substantial for all 10 items. One-factor confirmatory factor analysis model demonstrated an acceptable fit. The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling”, “personal care”, and “social life”. The lowest correlations were observed for the item “standing”.

Conclusions

The Oswestry Disability Index is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling,” “social life,” “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.

Trial registration

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-023-02307-w.

Keywords: Patient reported outcome measures; Pain measurement; Psychometrics; Disability evaluation; Surveys and questionnaires; Low back pain; Orthopedic procedures

Introduction

At least 200 patient-reported outcome measures (PROMs) are used for different purposes in patients with spinal complaints, including those undergoing spinal surgery1. During the last four decades, the Oswestry Disability Index (ODI) has become a well-researched gold standard for assessing the severity of disability caused by back pain2–6. The ODI is the most commonly used PROM to assess the limitations of functioning in spinal conditions treated either operatively or conservatively7. In 2020, a review of different measures of disability caused by low back pain suggested that the Roland Morris Disability Questionnaire and the ODI are the most widely accepted scales for the task among people with spinal disorders such as herniated intervertebral discs, spinal infection, spondylosis, and spondylolisthesis, among many others8. The ODI has been translated into numerous languages, and modified versions have been suggested. However, the developer of the ODI Dr. Jeremy Fairbank stated that none of the modifications made to the ODI have proven to be better than the original one9.

The internal consistency of the ODI has usually been found to be good, with an alpha up to 0.90 or even higher10. This included the Finnish version of the ODI, which was also used in the present study11. Other studies have reported a slightly lower alpha of 0.7 to 0.812, 13. A review of 16 studies reported an overall good internal consistency of the ODI, with a Cronbach’s alpha of approximately 0.94.

Many previous studies have found that ODI is unidimensional14–16. However, other studies reported a two-factor structure11, 12, 17, 18. For example, exploratory factor analysis (EFA) of 60,000 people undergoing spinal surgery resulted in a two-factor structure of the ODI12. Another study employing the same ODI translation as that used in the present study observed a two-factor structure11. Confirmatory factor analysis (CFA) among 35,000 patients has resulted in substantial variability across the loadings of the ODI items on a common “disability” factor varying from 0.53 to 0.8119.

This variability in the alpha and factor structures of the ODI may be explained by differences in the settings and studied populations. For example, a population predominated by a particular age group or sex may demonstrate deviant scores concerning the ODI item “sex life”20, and people undergoing spinal surgery may score higher on the ODI than conservatively treated patients16. In addition, differences between samples in the overall disability level may affect the internal consistency of the ODI, which has been reported to have a better discriminative ability among people with more severe disability signaling owing to the existence of the floor effect21. A review comparing the ODI with the Roland-Morris Disability Questionnaire reported that both scales might have different internal consistencies across diverse populations and translations, calling for further research22. In 2018, a review of different PROMs in lumbar spinal surgery stated that while the ODI has been validated in diverse populations consisting of people with back pain, it has not been validated in patients undergoing lumbar spinal surgery3.

Although the ODI is an overall well-studied scale, there is still some uncertainty regarding its reliability and validity when applied to a particular population of patients undergoing spinal surgery. The objective of this study was to explore the internal consistency and factor structure of the ODI in patients undergoing spinal surgery.

Methods

Data were obtained from an ongoing register-based study of patients undergoing cervical, thoracic, or lumbar spinal surgery (CTL Study) at a university hospital. Patients responded to a survey ≤ 2 months prior to surgery. The survey contained questions on demographics and disability severity. The present study used data on patients who underwent lumbar spinal surgery of any kind between June 21, 2018, and August 17, 2021 (Table 1). Patients who had undergone more than one procedure during follow-up were excluded. According to the ethics board of the university hospital district, this register-based study does not require specific approval.

Table 1. Distribution of surgery codes according to the Nordic Classification of Surgical Procedures (NCSP) version 1.15
Procedure codeProceduren%
ABC16Microsurgical excision of lumbar intervertebral disc displacement43929
ABC36Decompression of lumbar nerve roots29720
NAG62Posterior fusion of lumbar spine with fixation, 2–3 vertebrae28219
ABC56Decompression of lumbar spinal canal and nerve roots27118
NAG66Posterior interbody fusion of lumbar spine, 2 vertebrae715
NAG63Posterior fusion of lumbar spine with fixation > 3 vertebrae544
ABC66Decompression of lumbar spinal channel483
ABC26Open discectomy of lumbar spine342
NAG61Posterior fusion of lumbar spine without fixation121
ABC07Percutaneous lumbar endoscopic discectomy40
NAG67Posterior interbody fusion of lumbar spine > 2 vertebrae20
NAJ32Posterior reduction of fracture of lumbar spine10

Age was defined as full years at the time of surgery. Body mass index (BMI) was defined as body weight divided by height squared and was expressed in kg/m2. The preoperative pain duration was defined as < 6 weeks, 6–12 weeks, 3–12 months and > 12 months before surgery. Back pain intensity was assessed using a visual analog scale varying from 0 to 100 points, with 0 indicating ‘no pain’ and 100 indicating the most likely pain.

The ODI is a questionnaire containing 10 items covering disability caused by low back pain. Each item was assessed on a six-level ordinal scale with ‘0’ describing ‘no limitation’ and ‘5’ describing ‘extreme limitation or an inability to function’. The total score is a percentage calculated by the sum of all answers divided by 50 (the maximum possible number of points) and multiplied by 100 as follows: ‘Total score = (∑item scores/50) x 100’. The equation was adjusted when the responses to one or more items were missing. The missing responses were not imputed, but considered ‘missing’. E.g., if one item response was missing, then the sum was calculated as (∑item scores/45) x 100. A score of 0% represents the highest possible level of functioning and independence, whereas a score of 100% represents the lowest possible level of functioning with total dependence. The Finnish version of the ODI was used11. The variables collected in this study were the same as those in the Finspine registry23. The methods of gathering these register-based data have previously been described by the present research team24, 25.

Statistical analysis

The descriptive characteristics of the sample were presented as absolute numbers and percentage or as means and standard deviations (SD).

Internal consistency

The internal consistency of the ODI was assessed using Cronbach’s alpha. Alpha ≥ 0.9 was considered excellent; ≥ 0.8, good ≥ 0.7, acceptable, ≥ 0.6, questionable; ≥ 0.5, poor and < 0.5 was considered unacceptable26. A sensitivity test was performed by excluding each item at a time. While, there is no consensus on a smallest reliable sample size for a factor analysis, it has often been suggested that a sufficient sample size for a factor analysis may be between 3 and 20 times the number of test items27. The present study used these ‘rules of thumb’, instead of probably more efficient power calculations like Satora-Sarris or Monte-Carlo method or Bayesian approach27, 28.

Exploratory factor analysis (EFA)

Data were randomly split into two equal parts and adjusted for age and sex. First of these two parts (n = 759) were used in the EFA to approximate the construct structure of the ODI. The other half (n = 756) was used for CFA. The goal was to determine whether the ODI measured only one latent trait (e.g., disability) or if there were other possible significant latent variables affecting the results. The results were analyzed numerically and graphically. EFA (principal factors) was applied with a minimum eigenvalue for retention set at > 1.0 (Kaiser’s rule)29. Retained and excluded factors were also explored visually on a scree plot accompanied by parallel analysis.

Confirmatory factor analysis (CFA)

This study employed CFA to verify the construct structure of the ODI, as seen in an exploratory factor analysis. CFA extends the abilities of EFA to measure errors in a model. The estimation procedure uses the maximum likelihood method, considering the covariances supplied as the input to be unbiased. For simplicity, the estimates were reported in a standardized form as correlation coefficients. A correlation < 0.2 was considered poor, from 0.21 to 0.4 fair, from 0.41 to 0.6 moderate, from 0.61 to 0.8 substantial, and > 0.8 perfect30.

To assess how well the model matched the observed data, the root mean square error of approximation (RMSEA) was used. First, the model fit was tested by assuming that there were no covariances between unique factors. After that, the modification indices suggested by the software were used to add covariances between factors (double-headed arrows in Fig. 1) one at a time, each time testing the lower 90% confidence limit (90% CL) of RMSEA closeness to 0.05 and upper 90% CL closeness to 0.10. The probability of RMSEA being ≤ 0.05 was also reported. Every insertion was considered plausible if it made logical sense and did not violate the assumption that the common and unique factors were uncorrelated. After achieving an acceptable RMSE value, no further covariances were imputed, and the overall goodness of fit was assessed using a chi-square test for the difference between the model used and a saturated model (a model with a theoretically perfect fit). The results were accompanied by Akaike’s information criterion, Bayesian information criterion, comparative fit index, Tucker–Lewis index, standardized root mean squared residual, and coefficient of determination.

Fig. 1
Fig. 1. Scree plot (n = 759)

Due to the heterogeneity in surgical procedures, to illuminate whether there was a difference between ODI performance by surgical procedure, the subgroup analysis was performed dividing the sample into two groups: ‘discectomy’ group (‘ABC07’, ‘ABC16’, ‘ABC26’) and ‘decompression’ group (‘ABC36’, ‘ABC56’, ‘ABC66’, ‘NAG61’, ‘NAG62’, ‘NAG63’, ‘NAG66’, ‘NAG67’). The alpha was calculated, and the scree plot for the EFA and the path diagram for the CFA (assuming the same covariance between measurement errors) analyses were drawn for each group.

All analyses were conducted using Stata/IC Statistical Software Release 17. College Station (StataCorp LP, TX, USA).

Results

Data were available for 1,515 patients (Table 2). Their average age was 58.5 (SD 15.8) years. Of these, 809 (53%) were women, and 706 (47%) were men. The mean ODI score was 43.4% (SD 17.4%). Of these, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots (Table 1). The most frequent reason for the surgery was “M48 spinal stenosis” (38%) (Table 3).

Table 2. Descriptive characteristic of the sample
VariablesMeanStandard deviation
Age, years58.515.8
Body mass index (BMI), kg/m228.55.0
Back pain severity, points60.426.8
Oswestry disability Index, points43.417.4
Pain duration before surgeryN%
< 6 weeks1188
6–12 weeks19613
3–12 months48733
> 12 months68146
Table 3. Distribution of main diagnoses codes according to the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10)
Diagnosis (ICD-10)Dg titlen%
M48Spinal stenosis57038
M51Intervertebral disc disorders31521
G55Nerve root and plexus compressions27118
M43Deforming dorsopathies18912
M47Spondylosis866
M41Scoliosis272
M71Bursopathies181
M53Dorsopathies151
M80Osteoporotic fracture91
Others151
Total1,515100

Internal consistency

The Cronbach’s alpha was good at 0.87 (95% CL 0.86 to 0.88) (Table 4). All items demonstrated good item-test and item-rest correlations. In addition, excluding one item at a time did not improve the alpha.

Table 4. Internal consistency of ODI (Cronbach’s alpha), n = 1,515
ItemnSignItem-test correlationItem-rest correlationAverage interitem covarianceAlpha
Item 1Pain intensity1515+0.660.580.670.86
Item 2Personal care1515+0.740.680.650.85
Item 3Lifting1515+0.700.620.650.85
Item 4Walking1515+0.610.500.680.86
Item 5Sitting1515+0.620.520.680.86
Item 6Standing1515+0.590.490.680.86
Item 7Sleeping1515+0.590.500.700.86
Item 8Sex life1515+0.750.630.590.86
Item 9Social life1515+0.760.680.630.85
Item 10Travelling1515+0.780.710.620.85
Total score0.650.87a

a95% CI 0.86 to 0.88

Exploratory factor analysis (EFA)

The EFA demonstrates the unidimensionality of the ODI. A single factor with an eigenvalue of 4.02 was retained (Tables 5 and 6; Fig. 1). Item loadings on this retained factor were moderate to substantial for all ten items, varying from 0.52 to 0.76. The level of unique variance varied from 0.43 to 0.73.

Table 5. Exploratory factor analysis – item loadings (n = 759)
ItemsFactor 1Uniqueness
Item 1Pain intensity0.600.64
Item 2Personal care0.700.50
Item 3Lifting0.650.58
Item 4Walking0.550.70
Item 5Sitting0.580.67
Item 6Standing0.520.73
Item 7Sleeping0.530.72
Item 8Sex life0.680.53
Item 9Social life0.720.48
Item 10Travelling0.760.43
Table 6. Parallel analysis (n = 759)
FactorsEigenvaluesEigenvalues averaged over 10 replicationsDifference
14.020.213.82
20.630.150.49
30.070.09-0.02
40.050.06-0.01
5-0.010.02-0.03
6-0.06-0.01-0.05
7-0.09-0.04-0.05
8-0.13-0.08-0.04
9-0.17-0.12-0.06
10-0.20-0.15-0.05

Confirmatory factor analysis (CFA)

The 1-factor model of the CFA model demonstrated an acceptable fit (Table 7). The covariances of measurement errors were imputed for items “walking”, “sitting”, “standing”, and “traveling” (Fig. 2). The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling” (0.76), “personal care” (0.74), and “social life” (0.69). The lowest correlations were observed for the item “standing” (0.44).

Table 7. Confirmatory factor analysis – goodness of fit (n = 756)
Fit statisticValue
Likelihood ratio98.154
chi2_bs(45)2828.010
p > chi20.000
Population error
Root mean squared error of approximation (RMSEA)0.053
RMSEA 90% CI, lower bound0.042
RMSEA 90% CI, upper bound0.066
Probability RMSEA < = 0.050.298
Information criteria
Akaike’s information criterion (AIC)22320.515
Bayesian information criterion (BIC)22478.003
Baseline comparison
Comparative fit index (CFI)0.976
Tucker-Lewis index (TLI)0.965
Size of residuals
Standardized root mean squared residual (SRMR)0.034
Coefficient of determination (CD)0.874
Fig. 2
Fig. 2. Path diagram of confirmatory factor analysis (n = 756)

Subgroup analysis

The subgroup analysis was performed dividing the sample into two groups: ‘discectomy’ group (n = 477 [32%]) and ‘decompression’ group (n = 1,037 [68%]). The alpha was 0.88 (95% 0.86 to 0.90) for the “discectomy” group, and 0.86 (95% CI 0.85 to 0.88) for the “decompression” group. The scree plot for the EFA and the path diagram for the CFA were very similar for all the models (Supplement 1).

Discussion

This observational register-based study investigated the internal consistency and factor structure of the ODI in 1,515 patients undergoing lumbar spinal surgery. The internal consistency of the scale was good. All items were found to have good item-test and item-rest correlations, and it seemed that excluding any single item from the questionnaire would not improve alpha. The EFA found that the ODI was unidimensional. CFA was conducted assuming a one-factor structure. The highest correlations between items and a common factor were found for items “traveling”, “social life”, “sex life”, and “personal care”. The lowest correlation was found for the item “standing”.

These results are in line with previous research that reported good internal consistency of the ODI4, 10, 11, 16, 21. This includes a study by Selva-Sevilla et al., which reported an alpha over 0.9 among patients with previous lumbar spinal surgery10. In addition, a review by Sheahan et al. found an alpha close to 0.9 in all 16 included studies4. Pekkanen et al., using the same translation of the ODI as in a recent study, also reported an alpha value close to 0.911. These results were similar to those of earlier reports on the unidimensionality of the ODI14–16, 19, 21, 31. A study of 35,000 patients with degenerative disease of the intervertebral disc observed a one-factor structure of the ODI and factor loadings between 0.58 and 0.81, which is similar to the present findings19. Similar loadings between 0.59 and 0.77 have been reported for the Italian translation of the ODI31. In line with the present results, a similar factor structure of the ODI was observed when applying the CFA19.

The unidimensionality of the ODI seen in this study contradicts some previous observations. Multiple studies have reported the two-factor structure of the ODI11, 12, 17, 18. A study among 60,000 patients undergoing spinal surgery observed the two-factor structure of the ODI when applying both exploratory and confirmatory factor analyses – the first factor included items “lifting”, “walking”, “standing”, “sex life” and “social life”, while the second factor contained items “pain intensity”, “personal care”, “sitting”, “sleeping” and “traveling”12. While some of previous studies have been conducted on larger samples, this fact might hardly explain the diversity in the results as the present sample size should be sufficient for exploratory factor analysis, as previously suggested27. While, there is no consensus on a smallest reliable sample size for a factor analysis, it has often been suggested that a sufficient sample size for a factor analysis may be between 3 and 20 times the number of test items. The difference between that report and the present findings might be related to the fact that more than half of the patients in that sample had significant comorbidities such as diabetes or arthritis32. Unfortunately, data on comorbidities were not available in the present register. Pekkanen et al. used the same translation as that used in the present study, reporting a two-factor structure, defining two factors as characterizing the activities of daily living and social life and another describing pain and activities in an upright position11. The difference from the present findings might be related to the small sample size of that study, leading to insufficient study power to conduct a factor analysis. Moreover, small samples might be the reason for observing the two-factor structure of the ODI when validating Arabic translations of the scale17, 18.

In line with this study, the Dutch version of the ODI demonstrated high correlations between a common factor and items “traveling”, “social life”, and “sex life”15. Similar results were observed in previous studies19, 21. Previous research has suggested that item “social life” might have the greatest impact on a common factor understood as health-related quality of life33.

The generalizability of these results may be affected by several factors. The study was conducted in a single, highly specialized university clinic; therefore, the results might differ in primary care. In addition, the results might be affected by particular age and gender distributions or the average level of disability; however, their effects were outside the scope of this study. There were a variety of symptoms, surgeries, and patient groups in the sample. For example, patients with a herniated disc tend to be younger and healthier than patients with spinal stenosis, who tend to be older and whose level of functioning can be low even without a spinal disorder. In the studied cohort, almost half of the respondents had a diagnosis of spinal stenosis, a clinical entity that is often not associated with severe pain, but rather with sensory loss and focal weakness motor. This fact may distort the generalizability of the results, as one of the criticisms of the ODI has been its heavy reliance on pain. The reason for “walking” and “standing”, two common complaints among patients with back pain, were found to be the two least important items in the confirmatory factor analysis was unclear. Due to a relatively modest sample size, any sub-sample analysis, which could clear out that phenomenon, was considered not advisable.

Further research may reveal the stability of the ODI psychometrics before and after surgery. For example, after surgery, pain and stiffness may affect responses to the ODI items. In addition, satisfaction with the results of surgery may affect the responses to particular items but not to others. There is also a need to investigate whether different comorbidities or prior spinal conditions affect the psychometric properties of the ODI. Rasch or item response theory analyses of similar populations are needed. Additionally, it is possible that there are some subgroups within the population of people undergoing spinal surgery that may demonstrate different patterns of the psychometrics of the ODI. Further research should focus on defining these groups.

There are several important clinical implications of these results. The good internal consistency of the ODI means that, in the studied population, all 10 items measure the same latent variable – disability caused by back pain. This is confirmed by the unidimensionality observed by a factor analysis. A unidimensional and internally consistent scale produces a composite score, which is comparable among different respondents. Thus, in a population that is similar to one studied here (people waiting for a lumbar spine surgery due to heterogenic reasons), the ODI composite score will describe reliably and comparatively the severity of disability. In addition to that, the present study completed the EFA with the CFA, which sort of ranked the importance of the ODI items, as perceived by the respondents, in this particular population. It seems that some items may be more relevant to the respondents than others. Because of that, while composite score is a good way to describe disability level on a group level, creating a functional profile of an individual patient could describe their disability severity with more precision. Such functional profile should be based on the scores obtained from the ODI individual items and it could be presented in a numerical or graphical form. In other words, the results suggest that the ODI is a reliable and valid scale in a heterogenic population of people expecting their spine surgery, and it is able to describe disability severity from two directions – as a composite score for a quick assessment or as a functional profile containing individual item scores for a more thorough evaluation on a personal level.

Conclusions

The ODI is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling”, “social life”, “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.

Section 6

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material — available with the version of record.

Acknowledgements

Not applicable.

Abbreviations

PROM
Patient reported outcome measure
ODI
Oswestry Disability index
EFA
Exploratory Factor Analysis
CFA
Confirmatory Factor Analysis

Declarations

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author contributions

All the authors: KK, SW, JA, KP and MS have significantly contributed to the writing of the manuscript. KK has been responsible for drafting the work and SW, JA, KP and MS have revised the manuscript based on their own expertise. KK has edited the manuscript based on other authors’ comments. All authors have approved the final version of the manuscript and the order of authors.

Funding

Not applicable.

Data availability

The data are available on a reasonable request from Mikhail Saltychev, Mikhail.saltychev@gmail.com.

Declarations

All the methods were carried out in accordance with the Declaration of Helsinki. Given the retrospective nature of the register-based study, the need for informed consent or ethics approval was waived by the Ethics Committee of the wellbeing services county of Southwest Finland.

Not applicable. The manuscript does not include information or images that could lead to identification of a study participant.

The authors declare no competing interests.

This was a register-based study that utilized the data stored in electronic patient records.

Sources

References

33 references, in the article's own order. Citation numbers in the text are this list's numbers (32 records are cited).

  1. Patient-reported Outcome instruments in spine Surgery

    Guzman JZ, Cutler HS, Connolly J, et al.

    2016Spine (Phila Pa 1976) 41:429–37 · PMID 26571179doi:10.1097/BRS.0000000000001211

  2. The Oswestry Disability Index

    Fairbank JC, Pynsent PB

    2000Spine (Phila Pa 1976) 25:2940–52 · PMID 11074683doi:10.1097/00007632-200011150-00017

  3. Do we have the right PROMs for measuring outcomes in lumbar spinal Surgery?

    Stokes OM, Cole AA, Breakwell LM, et al.

    2017Eur Spine J 26:816–2420170109 · PMID 28070683doi:10.1007/s00586-016-4938-x

  4. A review of culturally adapted versions of the Oswestry Disability Index: the adaptation process, construct validity, test-retest reliability and internal consistency

    Sheahan PJ, Nelson-Wong EJ, Fischer SL

    2015Disabil Rehabil 37:2367–74 · PMID 25738913doi:10.3109/09638288.2015.1019647

  5. Assessing dimensionality and responsiveness of outcomes measures for patients with low back pain

    Cleland J, Gillani R, Bienen EJ, et al.

    2011Pain Pract 11:57–69 · PMID 20602714doi:10.1111/j.1533-2500.2010.00390.x

  6. The Oswestry low back pain disability questionnaire

    Fairbank JC, Couper J, Davies JB, et al.

    1980Physiotherapy 66:271–3 · PMID 6450426

  7. Patient-reported outcomes in spine Surgery: past, current, and future directions

    Finkelstein JA, Schwartz CE

    2019J Neurosurg Spine 31:155–64 · PMID 31370009doi:10.3171/2019.1.SPINE18770

  8. Low back pain: critical assessment of various scales

    Garg A, Pathak H, Churyukanov MV, et al.

    2020Eur Spine J 29:503–18 · PMID 31916001doi:10.1007/s00586-019-06279-5

  9. Fairbank J. Comment on Do we have the right PROMs for measuring outcomes in lumbar spinal surgery? by O. M., Stokes et al. Eur Spine J. 2017;26(3):816–824. Eur Spine J. 2018;27:245–246. 20171025. 10.1007/s00586-017-5354-6.10.1007/s00586-016-4938-x28070683

    Authors not recorded

    · PMID 28070683doi:10.1007/s00586-016-4938-x

  10. Psychometric Properties Study of the Oswestry Disability Index in a Spanish Population with previous lumbar disc Surgery: homogeneity and validity

    Selva-Sevilla C, Ferrara P, Geronimo-Pardo M

    2019Spine (Phila Pa 1976) 44:E430–7 · PMID 30234803doi:10.1097/BRS.0000000000002867

  11. Reliability and validity study of the Finnish version 2.0 of the oswestry disability index

    Pekkanen L, Kautiainen H, Ylinen J, et al.

    2011Spine (Phila Pa 1976) 36:332–8 · PMID 20823785doi:10.1097/BRS.0b013e3181cdd702

  12. Measurement Properties of the Oswestry Disability Index in recipients of lumbar spine Surgery

    Cook CE, Garcia AN, Wright A, et al.

    2021Spine (Phila Pa 1976) 46:E118–25 · PMID 33038201doi:10.1097/BRS.0000000000003732

  13. Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses

    Lee CP, Fu TS, Liu CY, et al.

    2017Health Qual Life Outcomes 15:192 · PMID 28974227doi:10.1186/s12955-017-0768-8

  14. Rasch analysis of three versions of the Oswestry Disability Questionnaire

    Davidson M

    2008Man Ther 13:222–31 · PMID 17363319doi:10.1016/j.math.2007.01.008

  15. The Oswestry Disability Index (version 2.1a): validation of a Dutch language version

    van Hooff ML, Spruit M, Fairbank JC, et al.

    2015Spine (Phila Pa 1976) 40:E83–90 · PMID 25575092doi:10.1097/BRS.0000000000000683

  16. Reliability and validity study on the Hungarian versions of the oswestry disability index and the Quebec back pain disability scale

    Valasek T, Varga PP, Szoverfi Z, et al.

    2013Eur Spine J 22:1010–8 · PMID 23321978doi:10.1007/s00586-012-2645-9

  17. Validation of an arabic version of the Oswestry index in Saudi Arabia

    Algarni AS, Ghorbel S, Jones JG, et al.

    2014Ann Phys Rehabil Med 57:653–6320140804 · PMID 25262247doi:10.1016/j.rehab.2014.06.006

  18. The Oswestry index for low back pain translated into Arabic and validated in a arab population

    Guermazi M, Mezghani M, Ghroubi S, et al.

    2005Ann Readapt Med Phys 48:1–10 · PMID 15664678doi:10.1016/j.annrmp.2004.06.055

  19. The Oswestry Disability Index, confirmatory factor analysis in a sample of 35,263 verifies a one-factor structure but practicality issues remain

    Gabel CP, Cuesta-Vargas A, Qian M, et al.

    2017Eur Spine J 26:2007–13 · PMID 28646454doi:10.1007/s00586-017-5179-3

  20. Sex life and the Oswestry Disability Index

    Costa M, Marshman LA

    2015Spine J 15:1225–32 · PMID 25708794doi:10.1016/j.spinee.2015.02.022

  21. Psychometric properties of the Oswestry Disability Index

    Saltychev M, Mattie R, McCormick Z, et al.

    2017Int J Rehabil Res 40:202–8 · PMID 28368870doi:10.1097/MRR.0000000000000226

  22. Roland-Morris disability questionnaire and Oswestry Disability Index: which has Better Measurement Properties for Measuring Physical Functioning in nonspecific low back Pain? Systematic review and Meta-analysis

    Chiarotto A, Maxwell LJ, Terwee CB, et al.

    2016Phys Ther 96(20160414):1620–37 · PMID 27081203doi:10.2522/ptj.20150420

  23. The Finnish spine register (FinSpine): development, design, validation and utility

    Marjamaa J, Huttunen J, Kankare J, et al.

    2023Eur Spine J 32:3731–43 · PMID 37718342doi:10.1007/s00586-023-07874-3

  24. Change in functioning profile after cervical Surgery

    Widbom-Kolhanen SS, Pernaa KI, Saltychev M

    2023Int J Rehabil Res 46:35–4020221123 · PMID 36730181doi:10.1097/MRR.0000000000000555

  25. Saltychev M, Widbom-Kolhanen SS, Pernaa KI. Sex-related differential item functioning of neck disability index. Disabil Rehabil. 2023;1–7. 10.1080/09638288.2023.2180545.10.1080/09638288.2023.218054536803260

    Authors not recorded

    · PMID 36803260doi:10.1080/09638288.2023.2180545

  26. George D, Mallery P. SPSS for Windows step by step: a simple guide and reference. 4th ed. Allyn & Bacon; 2003

    Authors not recorded

  27. Minimum sample size recommendations for conducting factor analyses

    Mundfrom DJ, Shaw DG, Ke TL

    2005Int J Test 5:159–68doi:10.1207/s15327574ijt0502_4

  28. Applied Psychometrics: sample size and Sample Power Considerations in Factor Analysis (EFA, CFA) and SEM in General

    Kyriazos TA

    2018Psychology 09:2207–30doi:10.4236/psych.2018.98126

  29. The Application of Electronic Computers to Factor Analysis

    Kaiser HF

    1960Educ Psychol Meas 20:141–51doi:10.1177/001316446002000116

  30. User’s guide to correlation coefficients

    Akoglu H

    2018Turk J Emerg Med 18:91–3 · PMID 30191186doi:10.1016/j.tjem.2018.08.001

  31. Development of the Italian version of the Oswestry Disability Index (ODI-I): a cross-cultural adaptation, reliability, and validity study

    Monticone M, Baiardi P, Ferrari S, et al.

    2009Spine (Phila Pa 1976) 34:2090–5 · PMID 19730216doi:10.1097/BRS.0b013e3181aa1e6b

  32. Influence of comorbidities on patients reported outcomes in degenerative lumbar spinal stenosis

    Ferrero E, Lonjon G, Bouyer B, et al.

    2018Orthop Traumatol Surg Res 104:1031–620180901 · PMID 30179722doi:10.1016/j.otsr.2018.07.012

  33. Changes in the Oswestry Disability Index that predict improvement after lumbar fusion

    Djurasovic M, Glassman SD, Dimar JR, et al.

    2012J Neurosurg Spine 17:486–9020120921 · PMID 22998402doi:10.3171/2012.8.SPINE12614

Article record

The record

Status

Living reprint · journal article Journal version available

Status
Version of record: BMC Surgery 2024
Journal version
BMC Surgery (2024) · doi:10.1186/s12893-023-02307-w
Confirmed
2024-01-03
Licence
CC BY 4.0

This reprint has no DOI of its own: cite the journal article.

The journal's version is the version of record. This page re-typesets it under the article's licence; where they differ, the journal's version is authoritative.

Version history

  1. Published in BMC Surgery2024-01-03
  2. Living reprint on Literature Decoded2026-10-01
  3. Reprinted here2026-10-01
  4. This HTML2026-10-01

Cite this article

Citation
Koivunen K, Widbom-Kolhanen S, Pernaa K, Arokoski J, Saltychev M. Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery. BMC Surg. 2024;24:13. doi:10.1186/s12893-023-02307-w
BibTeX
@article{Koivunen2024Reliability,
  title     = {Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery},
  author    = {Konsta Koivunen and Sara Widbom-Kolhanen and Katri Pernaa and Jari Arokoski and Mikhail Saltychev},
  journal   = {BMC Surgery},
  year      = {2024},
  volume    = {24},
  pages     = {13},
  doi       = {10.1186/s12893-023-02307-w},
  pmid      = {38172794},
  publisher = {BMC}
}
RIS
TY  - JOUR
TI  - Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery
AU  - Konsta Koivunen
AU  - Sara Widbom-Kolhanen
AU  - Katri Pernaa
AU  - Jari Arokoski
AU  - Mikhail Saltychev
JO  - BMC Surgery
PY  - 2024
VL  - 24
SP  - 13
DO  - 10.1186/s12893-023-02307-w
PB  - BMC
SN  - 1471-2482
UR  - https://doi.org/10.1186/s12893-023-02307-w
ER  -

Cite the original article (the version of record), not this reprint.

Take it with you

One self-contained HTML file: the text, data and figures, readable offline.

Disclaimer and limitations

Educational summary of research findings; not medical advice. Discuss care decisions with a qualified clinician.

The findings apply to the included study populations and may not generalise to every person or setting.

Licence and attribution

This page reproduces Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery by Konsta Koivunen, Sara Widbom-Kolhanen, Katri Pernaa, Jari Arokoski, Mikhail Saltychev, first published in BMC Surgery 2024;24:13, doi:10.1186/s12893-023-02307-w, PMID 38172794, PMC10765861. © The Author(s) 2024. It is used under the CC BY 4.0 licence.

Changes made:

The words, data, figures and conclusions are the authors’. Literature Decoded is not the publisher of record and does not claim endorsement by the authors or the journal. The version of record is the journal’s; cite it.

Licence statement in the article: “Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.”

Are you an author of this article? Claim it or ask us to take it down.

Cite this article

Living reprint · journal article